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Health Inequalities

Volume 464: debated on Tuesday 9 October 2007

A large number of hon. Members wish to speak in this debate and, in order to accommodate all of them, brevity will be required on everyone’s part. It is my intention to begin the winding-up speeches at 12 o’clock.

It is a great pleasure to be under your eagle eye today, Mr. Illsley, while we discuss this important issue.

It is well recognised that inequalities exist in all advanced countries, but it is equally sure that where the extremes are closer, the societies are better. The issue is not just a moral one but one of self-interest for everybody in the country. The Labour party exists to lessen such inequalities. That was why it was formed, and it is why many Labour Members joined it.

Inequalities in health are stark. The life expectancy gap between those in the poorest and richest parts of the country is often 10 years or even more. Morbidity—the way that people feel about their health—follows the same path. Labour recognised that in our 2001 manifesto, in which we stated:

“There has been a growing health gap between rich and poor. Beyond other commitments to combat child poverty and poor housing, we will tackle the long-standing causes of ill-health and health inequality”.

In our 2005 manifesto, we stated:

“By 2010…we plan to reduce the health inequalities that exist between rich and poor.”

That aim was exemplified in the policy document that went to all Labour candidates for that election, in which we stated:

“It is simply unacceptable to us that the opportunity for a long and healthy life today is still linked to social circumstances, childhood poverty, where you live, how much your parents earned, how much you earn yourself, your race and your gender…Though health inequalities remain, we are determined to use a third term in office to reduce them further.”

That is clearly recognised. Indeed, in his first speech on taking office, the new Secretary of State concentrated on health inequalities. There is no difference between ourselves and the Government on what we want to achieve.

I shall not take any lectures or strictures from the Conservative party on the issue. In all the time that it was in office, it refused to allow it to be discussed. The recent Joseph Rowntree Foundation report indicated clearly that, in the years between the 1980s and 2000, health and social inequalities widened dramatically. Rather than any strictures, an apology would be in order.

To tackle health inequalities, we must first identify them. Two headline figure indicators have been identified: infant mortality and life expectancy. In November 2004, spearhead authorities were identified to tackle health inequalities. They were classified as those in the worst 20 per cent. of authorities in England in three of the following five areas: cardiovascular mortality; cancer mortality; life expectancy at birth for both males and females, and the index of multiple deprivation. Wigan is in the worst 20 per cent. in all five categories.

Health inequalities are recognised as an issue and identified as a geographical problem. So what about the means and resources of tackling them? The Government have a formula whereby they distribute 75 per cent. of their health budget to primary care trusts. That formula measures health needs by taking account of age, sex, mortality, morbidity, the cost of living and economic deprivation, and it produces a target for each PCT. I should emphasise that it is a Department of Health formula—it is the Department’s assessment of the health needs of each area. However, the actual funding does not follow the targets set by that formula. It is guided by them, but does not follow them. The guidance is not particularly well followed, as I shall show shortly.

Prior to the 2005-08 comprehensive spending review round, a group of Members pushed the then Secretary of State, the right hon. Member for Airdrie and Shotts (John Reid), to speed up the pace of change and the rate at which PCTs get closer to their targets. I wish to pay tribute to him, because we were reasonably successful, particularly in the areas that were seriously below their target funding allocations. For instance, in 2005 Easington PCT was £25.5 million below its target funding. It is now £6.5 million below—a shift from 16.2 per cent. to 3.5 per cent. below. That was replicated in many other areas that were seriously below target in 2005, and we should pay tribute to the then Secretary of State for making those massive improvements, which laid a firm foundation upon which we can build for our next comprehensive spending review round. This debate is essentially about making further progress on that.

Despite the efforts of the then Secretary of State in the 2005-08 round, primary care trusts still do not receive the share of funding that the Department says they need to tackle the health needs of their populations. The differences are stark, and many of them are inexplicable, especially when set against the Government’s stated aim of reducing health inequalities. Ashton Leigh and Wigan PCT is £11 million—2.4 per cent.—below its funding target. Westminster PCT is £41 million, or 11.6 per cent., over its target. Newham is £15 million, or 3.2 per cent., below; Richmond is £28 million, or 13 per cent., above. Bradford is £20 million, or 3.5 per cent., below; Brent is £20 million, or 4.8 per cent., above. Liverpool is £25 million, or 3.2 per cent., below; Lambeth is £56 million, or 12.6 per cent., over its target. Incidentally, that last example shows a totally inexplicable increase, because in three years Lambeth has moved from being £25 million over target—6.4 per cent.—to being £56 million, or 12.6 per cent., over. Rather than moving in the right direction, some PCTs are moving in totally the wrong direction.

I emphasise that the issue is not one of north versus south. It is about deprived areas throughout the country, and deprived boroughs in London are as underfunded as many of the areas in the north and the midlands. Newham is £15 million below its target, Barking and Dagenham £10 million below, Tower Hamlets £14 million below and Hackney £15 million below. The matter is not north versus south, it is about health inequalities, deprivation, health need and funding PCTs to address their health needs and reduce inequalities.

I represent the poorest region of the UK, Cornwall and the Isles of Scilly, which is below its target for the funding available to the PCT. Does the hon. Gentleman agree that it is inappropriate that, in such circumstances, PCTs with appointed, not elected, members, were forced by the Department of Health to spend 15 per cent. of their limited resources within the acute sector in private hospitals, rather than support struggling NHS hospitals? Does the hon. Gentleman agree that such decisions should be made locally, not enforced on PCTs by the Department of Health?

I do agree, and that is an issue that we have addressed previously. Indeed, the Department has made changes to the second and third round of independent sector treatment centre procurement, and those changes will address the problem. While I understand the hon. Gentleman’s point, it is not fundamental to the issue that we are discussing, which is about overall health funding rather than how the funding is spent in particular areas. However, I take his point.

I shall give an example with which my hon. Friend may not be familiar, from my own area of Wolverhampton. Infant mortality improvement has completely stalled in recent years, and male life expectancy is rising at a much slower rate than national male life expectancy. That may well be related to Wolverhampton City PCT’s having been under formula for many years.

My hon. Friend is absolutely right and raises an important issue. We have not merely been underfunded for the past three years; the underfunding is historical and goes right back to 1948, when the NHS was formed. The number of GPs that our PCTs are able to employ and the number of interventions that we can make in our areas are seriously lower than in the areas that I have identified as being over target. That is not only because of the funding of the past three years, but because of the nature of the funding, historically. All that impacts on health inequalities. Whatever happens in this comprehensive spending round and whatever Ministers are able to do about the problem, the impact will not be immediate or dramatic—it will be a long haul. We must recognise that it will take a long time to reduce the health inequalities in our country, and we must make a start now.

In August 2007, guidance was given to spearhead PCTs on reducing standard mortality ratios in a range of areas. In Wigan, although cancer mortality rates are down, they are not down as much as for the country as a whole, so the gap is widening. Life expectancy in Wigan is improving, but only at the national rate—the gap is staying the same. With cardiovascular diseases such as heart attack and stroke, our standardised mortality ratios are consistently 40 per cent. higher than those for the UK, nationally. Those PCTs that have been identified as spearhead trusts have been given no extra funding to tackle those issues. Where specific funding has been given—for smoking cessation services, for example—and practice nurses have been used in GP surgeries to screen for cancers, there have been dramatic improvements. The lesson that we can learn from that is that additional resources bring improved results.

In 1997, in a reversal of the disgraceful attitude of the previous Tory Government, Labour commissioned Sir Donald Acheson, the then chief medical officer, to review health inequalities. His report made 39 recommendations, only three of which were directly related to the NHS. Inequalities in health indicate that there is wider deprivation and have an impact on that deprivation. This is an important point. We are not just talking about inequalities of health as a result of deprivation: inequalities of health and in the way in which people are unable to contribute to the local economy help to create deprivation in those areas.

Other agencies, particularly our local authorities, will have to tackle areas of multiple deprivation. That point was recognised in the 2002 Wanless report, in which Wanless drew particular attention to personal social services. Many local authorities and PCTs, including my own in Wigan, now have joint commissioning and pool the funding for those services. But there we hit yet another difficulty—many of the local authorities covering the areas in which PCTs have below-target funding are themselves inadequately funded. Just as the Department of Health has a formula to calculate health needs and allocate funding accordingly, so does the Department for Communities and Local Government. Just as that formula is not followed by the DOH, it is not followed by the DCLG. Almost inevitably, the local authorities that are underfunded in health are also underfunded in local government. Wigan is £10 million underfunded in local government, while Westminster is £18 million overfunded. Bradford is £12.5 million under, while Brent is £21.5 million over; Newham is £15 million under and Barking and Dagenham is £14 million under, while Richmond is £13.5 million over and Wandsworth is £49 million over.

Will my hon. Friend allow me to add the figures for Sunderland to that list? My local authority, which also represents one of the more deprived catchment areas, estimates that it was down just under £7 million in 2006-07 and £6.4 million in the current financial year.

I think that all Labour Members present could give figures for our areas and show that we are underfunded not only with our health allocation, but in local government. That is important because of the way in which they interact and affect each other. If we are to tackle health inequalities, we must also tackle other areas of deprivation.

I appreciate that it is not in the purview of the DOH to review local government funding, but, as Sir Donald Acheson made clear and as Wanless has re-emphasised, we will not reduce health inequalities through the NHS alone. The two Departments must tackle the problem jointly. To continue the double whammy of underfunding PCTs and local authorities serving the same local population will mean that those populations will continue to suffer health and social inequalities.

The debate is timely because this afternoon the Chancellor of the Exchequer will announce the comprehensive spending review for 2008-11, which will allocate health and local government resources nationally. In his 1998 report, Sir Donald Acheson said that only three of his 39 recommendations related directly to the NHS. The most important of those three was the need for a

“more equitable allocation of resources”

within the NHS.

I totally support my hon. Friend’s comments, but does he accept that there is also a problem within areas? A problem with semi-rural constituencies is that people living in the more rural areas who do not have income to support them are often very disadvantaged in health terms. It is important that we drill down—I suppose that is the in term—to look below the macro picture at what is happening on the ground. Does he agree?

I do agree. In my borough, the best ward is at around the national average, whereas six or seven wards are in the bottom 3 per cent. of deprivation in the country. Within each of our areas will be areas that are relatively well off and healthy, and areas that are significantly unhealthy and significantly worse off.

The debate is vital for all our constituents who die before their time or who suffer debilitating illnesses and grow old before their time. The size of the national health cake has been decided, and we will hear an announcement on that this afternoon. A more equitable distribution of that cake will allow PCTs such as Wigan to contribute to achieving the Government’s aim of making serious inroads into the health inequalities in this country.

I shall be brief, to allow others to speak. I congratulate my hon. Friend the Member for Wigan (Mr. Turner) on securing this timely debate. I also congratulate the Secretary of State; it gladdened my heart that he gave a speech to the Socialist Health Association at Toynbee hall. Inequality was mentioned all through that speech, which should be bedtime reading for every chair of every PCT and every chief executive officer who thinks that they know something about health.

I want to speak briefly about my role as chair of the powerful all-party group on cancer. We have very much played our part in developing a programme with the Government. The first cancer reform strategy, cancer plan one, has come out and we are now looking at a cancer plan two—although we call it our cancer reform strategy—with patient groups and others. I hope that money will be put into that strategy. It is partly about addressing inequalities related to gender, race and sexuality, but other issues also need to be addressed. I am told that many homeless people do not get health service support, such as the identification and diagnosis of early-stage diseases such as cancer in their environment. The St. Mungo’s Trust in London, which looks after the homeless, has really accentuated that point.

People who have rarer and less-talked about cancers do not get the same kind of support as those who have breast cancer and prostate cancer. Incidentally, there is not as much support for prostate cancer, as for breast cancer, but identification levels are on their way up. People with ovarian, pancreatic, liver and brain cancers do not get the same support, which is necessary to repair their lives and cure those cancers.

The lack of information does not help and inequality exists, particularly in black and minority ethnic communities. My PCT in Norfolk—I am glad to see my hon. Friend the Member for Great Yarmouth (Mr. Wright) here—has suddenly decided that it is worth putting out some documents in different languages. It has suddenly decided that Portuguese migrant workers, Lithuanian policemen and others deserve to have something written in their languages. It has taken it 10 years to see that, but it has a long way to go. I hope that the PCT is embarrassed, and that that fact is reported if anybody is listening. The problem is growing. Minority groups exist and do not get the whack of support from the health services that they need.

There was a report in The Lancet Oncology this summer about inequalities on another level—between us in the UK and other European countries. The report dealt particularly with two children’s cancers: a rare brain cancer called neuroblastoma and Wilms tumour, which is a kidney tumour. On looking at the survival rates, we see that we are lagging behind. There are many arguments about early identification and so on, but the situation has gone on a long time and we should be worried about it. Our first cancer plan is at an early stage of development and perhaps the data will improve as time goes by, but we should not sit back and expect that to happen. We have much more to do.

The answer is not always just to shovel money into the system willy-nilly; it is about directing money to the right places. I was on the Science and Technology Committee when the first cancer plan was set up. We investigated where the extra £640 million had gone, but it was difficult to find out from the PCTs at that time—a few years ago—what they had done with the money. Was it ring-fenced for cancer or did it go elsewhere? Was it used for car parks, and so on? We did not get to the bottom of that, but our questions precipitated a further investigation by the Department of Health. Funding for cancer research, treatments and cures was meant to be spread across the country, but it was unequal.

Cancer has been the doyenne of the health service, given what we have achieved in the past 10 years. It is a paradigm for many other illnesses such as diabetes, mental ill health and so on. Patient support groups have worked together and with the Government to improve services. Stimulating charities to join together is important.

I mentioned children earlier, but we must also think about the carers in the process. In some places in this country, carers are respected and given support. For example, if a child has to get treatment at the local hospital or clinic, a parent must go with them. If the parent works, they have to get time off work and lose pay. Things are not fair in this country—some people are not allowed time off. A managing director or football club manager, for example, presumably can take time off—unless they are managing Norwich City, when they need as much time as possible to achieve anything. However, I am sure that Members will take my point that it is easier for some people to get time off work. We must consider whether funding has been fairly adjusted in this country. Many young people are not getting that kind of support from their carers.

More men die of cancer than do women, particularly older men. I have mentioned ethnic minorities, particularly the women in them. The all-party group on cancer runs the Britain Against Cancer conference. Last year’s conference was attended by more than 300 people, with a waiting list just as long. Patient groups and other information groups speak about the issues and inspire us to do things. Some young women spoke about outreach projects that they were involved with in parts of London and elsewhere in the country, through which small groups of people address the big cultural differences in understanding the treatments that can be applied in various situations. Their problem—a real problem that I hope the Government will address—is that they set up a project that achieves greatness in year one and more greatness in year two, but then the money falls. When voluntary groups do such things, we must ensure that they are able to continue in office and to support the people out there.

I finish on this note. One of the Ministers and I will be attending a dinner tonight, and I point out that there are people lurking in the background who want to privatise the health service. Such people are pushing the idea that they can deliver better cancer services than the NHS. We should beware of the fact that they will be waiting in the wings with their American supporters if the Government do not precipitate action through the new reform strategy.

Ever since my election to this House in 1997, health inequalities has been one of my major campaigns. I therefore congratulate my hon. Friend the Member for Wigan (Mr. Turner) on securing this important debate.

Regrettably, Bolton is included in a list of the 15 per cent. most deprived boroughs in the country, with 37 per cent. of its population living in the 20 per cent. most deprived wards. Of the three Bolton parliamentary constituencies, mine demonstrates the most deprivation, followed by Bolton, North-East, then Bolton, West. The Royal Bolton hospital, which has the second busiest accident and emergency department in Greater Manchester, is situated in the heart of my constituency.

Several diverse ethnic minority communities, mainly from south-east Asia, live in Bolton, particularly in my constituency. They present special challenges to the national health service, such as different diseases, cultures and styles of living. For example, 23 different languages are spoken in one of my primary schools. Such a situation is a challenge to the NHS.

Bolton is a low-wage economy. The median pay is only £317.60 per week, compared with the England average of £369.40 and the north-west average, which stands at £344.20. Worklessness, as represented by those receiving jobseeker’s allowance, incapacity benefit or severe disablement allowance, is high at 12.9 per cent. The figure reaches 49 per cent. in the most deprived wards in Bolton.

In the past, the principal industries in the town were mining and cotton textiles, supported by heavy engineering. They have caused considerable incapacity and disablement, particularly in our older population. That is a feature of all the old industrial towns. In some Bolton wards, life expectancy today is under 67, with a 15-year gap between the rich and poor areas of the town.

In 1997, the Wigan and Bolton health authority was considerably underfunded; I believe that the figure was about £14 million at that time. I compliment the Government on introducing the pace of change policy, which has brought more money to constituencies such as mine. Unfortunately, as my hon. Friend pointed out, the pace of that policy has been rather slow, and in some cases we have actually gone backwards, as I shall demonstrate.

There are just not enough doctors or dentists in Bolton. That is particularly true of the most deprived areas of the town. Bolton’s primary care trust, which is coterminous with the borough boundary, is currently just over 2 per cent. away from target in the three-year allocation leading up to 2007-08. That equates to a shortfall of £8 million. Compare that with affluent Richmond and Twickenham PCT, which receives 12 per cent., or £27 million, above target. As my hon. Friend said, such discrepancies simply cannot be right.

In November 2004, the Government defined spearhead local authorities as those rated in the worst 20 per cent. in the country in three out of five categories, which my hon. Friend defined. Bolton qualifies in four of those categories. The average spearhead PCT was 1.1 per cent. or, on average, £2.6 million under target in 2006-07—Bolton is at 2 per cent.—while the non-spearhead PCTs received, on average, 0.5 per cent. or £1 million over target. The differential is reducing. Bolton PCT’s figure has reduced, but only from 2.0975 per cent. to 2.035 per cent. Not surprisingly, especially in view of Bolton’s health legacy, which I described, I would support accelerating a reduction in the health inequalities that have existed not only in my constituency but in others for far too long.

A recent analysis of cancer mortality rates in the north-west for spearhead versus non-spearhead PCTs has shown an actual worsening of the position by 4.4 per cent. for men and 19.7 per cent. for women. Instead of the 6 per cent. absolute reduction required by the Government’s public sector agreement targets to reduce health inequalities between the fifth most deprived areas and the rest by 2010, the gap has increased in the north-west. Stomach, cervical, lung, and bladder cancers are of greatest concern, especially among women.

I assure the Minister that Bolton is doing everything possible within its financial capabilities to reduce the health inequalities in our town, even by using non-health pots of money such as neighbourhood renewal funding to pump-prime interventions, but we need more help than we are currently getting. That is what this debate is about.

We are discussing health, and I am afraid that my health is not particularly good today, so I shall not speak for long because my voice might not last. I want to speak because this debate is important, and I congratulate my hon. Friend the Member for Wigan (Mr. Turner) on securing it, and on speaking so strongly on this important subject.

I speak for Luton, which is seriously and consistently underfunded, and has been for many years. It is the most underfunded health area in the relatively prosperous eastern region, yet we have the greatest health inequalities, enormous levels of heart disease and diabetes, and serious mental health problems, which are not being addressed as they should be because we are underfunded.

I was recently called to a meeting by Amicus, which is now part of Unite, because its members include health visitors and there are not enough health visitors. Luton has a large young population with many children and a high birth rate, so we need health visitors and we do not have enough.

I have recently been informed that Luton has the longest waiting times for musculoskeletal treatments. Again, that is simply because of underfunding. Some non-statutory funding areas have been cut—for example, foyers for people with mental health problems—and there are funding squeezes all around. There was a health funding freeze two years ago, when Luton should have been treated rather better than some other areas, but it was treated worse and had the worst health funding cuts of any primary care trust in the region. Others in the more prosperous leafy shires and relatively middle class areas were allowed to increase their spending when we were forced to cut ours. That was gross inequity by any standard.

More recently, in the past year or so, we have had a savage cut in our walk-in centre. Walk-in centres were recently trumpeted by the Prime Minister, and the then Secretary of State for Health opened our walk-in centre with a great fanfare, but its hours were later cut to a quarter of what they had been. It was a wonderful facility that took pressure off GPs and the local accident and emergency department, and enabled people who might not have gone to their doctor to drop in. Some people with health problems, particularly middle-aged men, do not go to their doctor when they should, and walk-in centres pick up on conditions.

I do not blame the health professionals, who do their best in difficult circumstances, and I commend my local patient and public involvement forum, which has done a tremendous job in lobbying on behalf of local patients. Some months ago it called a special meeting to discuss the walk-in centre and other matters with representatives of the primary care trust and the strategic health authority. The PCT officers, to their credit, turned up at that meeting. They had a hard time, but they turned up. The SHA officer did not turn up and there was a vacant seat. I understand that a few days later, the SHA called the PCT officers to an early-morning meeting elsewhere in the region and told them to get the PPI in line. The SHA’s behaviour was outrageous. Not only did it impose unfair spending cuts; it lambasted its own officers in the PCT for not keeping local patient representatives in line.

Luton has serious problems, which must be addressed. I have written many times and at length to successive Secretaries of State for Health about our funding problems. I want Luton to be treated fairly in future, and I urge my right hon. Friend the Minister to look carefully at Luton’s funding and at other areas that are similarly poorly treated, to ensure that we have fair funding levels in future.

Thank you, Mr. Illsley, for giving me the opportunity to participate in this important Adjournment debate. There is no doubt that social care funding has had great difficulty in keeping pace with demand. The pressure on social care services from rising demand is well rehearsed and reflects the experience of Doncaster and Barnsley, which are my home authorities. People are living longer with improvements in health care from birth to old age, so more people have complex dependency needs. They have greater expectations for more and higher quality services. The situation has been compounded by recent developments in the NHS—for example, long-stay hospital closures. Treating more people more quickly with earlier discharge requires more intensive care in the community and places an extra burden on social care services.

Within social services, better assessment and early intervention, rather than reducing long-term costs, is creating pressure to offer more in the way of early, targeted support. More investment is needed for the shift from spending on intensive care services to prevention and individualised support.

The Government face a difficult scenario, but it is compounded by the inequalities in the health funding system, as all hon. Members who have spoken have said. This debate is not just about health funding inequalities; more importantly, it is about health inequalities in general.

You will be familiar with the health profile of my constituency, Mr. Illsley, where more than one in three households has at least one disabled person. It has the highest number of individual claims—more than 12,500—for chronic bronchitis and emphysema from former miners. Former miners in my constituency have received more than £100 million from the Labour Government. They would not have received that if we had had a Conservative Government, and those claims are a legacy of the mining industry.

The latest figures that I have for mortality rates for cancer are for 2005-06 and are based on 100,000 people of all ages. The average rate in England is 177; in Barnsley it is 204.35 and in Doncaster it is 207.68. Turning to the mortality rate for chronic heart disease, the average rate in England is 101.8; in Doncaster it is 115.8 and in Barnsley it is 145.02. That is 40 per cent. higher than the national average, and provides a snapshot of the sort of picture that we face in Barnsley and Doncaster. Yet overall Government funding bears little relationship to assessed needs, with current grant differing from some 130 per cent. over target to some 23 per cent. below target. Doncaster is 6.8 per cent. below target and Barnsley is 9.3 per cent. below target. Around 95 local authorities nationally are below target funding by some £686 million. Of those, 37 are part of the special interest group of municipal authorities outside London—SIGOMA—and are losing £239 million this year. Both Barnsley and Doncaster are members of SIGOMA.

I have a confession to make. I was one of the three founding fathers of SIGOMA when I was leader of Barnsley council. The other two gentlemen in the frame were Councillor Peter Smith from Wigan and Councillor George Gill from Gateshead. That was one of my greatest achievements as leader of the council. [Hon. Members:One of many.”] Yes, one of the many achievements. It is important that the Government revisit the issue, so that resources can be more effectively targeted at areas of greatest need.

The efficiency of local authorities has been widely acknowledged in recent weeks, and the Local Government Association lobbying of Ministers to switch 0.5 per cent. of the NHS’s expected budget of £100 billion—that is £500 million—to social care should be widely welcomed and supported, because there is evidence that such a switch would deliver better value for money.

In conclusion, the issue is one of fairness and equity, and I would like the Minister to answer this specific question when she responds. How can it be right that Barnsley, where the death rate from chronic heart disease is 45 per cent. higher than the average, is underfunded to the tune of 9.5 per cent. below target? The Barnsleys and Doncasters of this world do not want more than other areas. We would be more than happy with our fair share.

I thank my hon. Friend the Member for Wigan (Mr. Turner) not only for securing the debate, but for the careful way in which he put forward his arguments and also for mentioning Newham many times. I thank him too for characterising the debate not as one between north and south, but as one about health inequalities. I am really grateful to him for framing the debate in that way.

This debate is very important for my constituency, which is the eleventh poorest part of England and Wales. In the distance of the short journey on the Jubilee line from here in Westminster to my home in Newham, life expectancy for children decreases by six years. Put simply, my local authority does not have the money that it needs to deal with health inequalities. In the year 2007, the locality where people live should not determine lifespan, but the reality is that it does.

I acknowledge, as have other hon. Members, the findings of the Black and Acheson reports that health inequality has its determinants in poverty, low income, poor housing, lack of education, lack of security and high levels of stress. It is therefore clear that any redress in health inequality needs to engage more players than the NHS alone. My hon. Friend the Member for Wigan mentioned that we need a partnership with the Department for Communities and Local Government in dealing with these issues, and he is absolutely right.

There is no need to be an expert in Maslow’s hierarchy of needs to understand that living on a low income in a high-cost capital has an impact on healthy choices—food, leisure and education choices—and therefore on the stress levels of families struggling to make ends meet while living cheek by jowl with the enormous wealth of the City. It does not take a genius to understand that it is very difficult for families in temporary accommodation, living in the private sector in homes that they can barely afford, and moving every few months or years while they wait the 13 years that it takes to get a house in the public sector, to have a lifestyle that maintains good health.

Newham has a housing waiting list of 30,000 families—families that are moved from place to place while they wait, often unable to put down roots in an area, and are therefore unable to find their way on to doctors’ waiting lists. If they are successful in registering on the very full lists, they are often then subject to another move and another search for the most basic of health requirements—access to a doctor. Is it any surprise, therefore, that such families access their health care erratically, through the accident and emergency services of the local hospital, too late for there to be an impact on their health? That results in a shorter lifespan and means that such people live longer in ill health than those in better circumstances.

The continued inequalities experienced by my constituents are exemplified by the infant mortality rate, which in Newham fell by 4 per cent. between 1998-2000 and 2003-05, although it fell by more than 10 per cent. in London as a whole. Obviously, all improvements in health are welcome, but the worrying growth in inequality simply cannot be ignored. There are clear inequalities in outcomes, but also great disparities in inputs, such as funding per person. North-east London contains several deprived boroughs with some of the lowest life expectancies in England. In 2004-05, the average expenditure per weighted head of the population was £1,090, compared with the north-west London figure of £1,311. Indeed, according to the Government’s own weighted capitation calculations, and as my hon. Friend kindly stated, Newham Primary Care Trust currently receives £15 million less than it should each year. Such underfunding in an area such as mine is frankly immoral.

Last year, I was forced to have a meeting with the then Secretary of State for Health to express my deep concern at the requirement made by NHS London that Newham PCT contribute 3 per cent. of its 2006-07 budget to a financial risk pool for London. The risk pool was required to ensure that the NHS in London as a whole was in financial balance. Although I understand that requirement from the wider perspective of getting the NHS on budget, it is hard to stomach given the local circumstances. Newham PCT has a consistent record of hitting its financial targets. The deficit in London had been run up by other PCTs, many of which have been, and continue to be, overfunded according to weighted capitation targets. My hon. Friend referred to that too. Along with other demands, such as that for a 15 per cent. saving on management and administration costs by 2008 as a consequence of commissioning a patient-led NHS, the requirements mean that the PCT is facing significant financial pressures while attempting to make real progress towards narrowing health inequalities.

I am confident that this Labour Government are facing up to the enormous challenge of inequalities in health care—something that the previous Government failed to do. However, while there is much to praise, good intentions will be carried through only if constituencies such as West Ham and the other constituencies mentioned here this morning receive better and more appropriate funding and health care—health care designed around the needs and realities of living in a borough such as my own.

It is incumbent on each of us to thank my hon. and good Friend the Member for Wigan (Mr. Turner) for securing such an important debate. Each of my Labour colleagues who has spoken previously has covered the general issues adequately, so I shall keep my comments specific to my own city of Salford and to the north-west.

For Salford, health inequalities are not just about quality of life, important though that is; they are about the actual lengths of people’s lives. They are important to the SIGOMA organisation, which was mentioned earlier, because Salford is an active member of that group. As to the more general comments made by my hon. Friends, let me just say that if we are to deliver the joined-up services for which we strive, and improve the health of our citizens and successfully tackle social problems in our neighbourhoods, the Government need to move swiftly towards full implementation of their own funding targets.

In Salford, the evidence is stark. Despite huge improvements in the general health, housing, employment, income and education of Salford residents, the relative inequalities in health in parts of the city remain as great as they were 100 years ago, if not greater. In parts of Salford, male life expectancy based on 2003-05 figures is 73.8 years, compared with 76.9 years for England as a whole. The equivalent figures for women are 78.4 years in Salford, compared with 81.1 years elsewhere. That means that male life expectancy in Salford is the sixth lowest in England, and female life expectancy is the fifth lowest. Life expectancy in Salford has improved in recent years, year on year, but the gap for male life expectancy between Salford and England as a whole—3.1 years—is the same now as it was eight years ago. For women, it has widened from 2.3 years to 2.7 years.

The death rate from smoking in Salford is higher than the north-west and England averages and is the fifth highest in England. Smoking accounts for 505 deaths in Salford every year—deaths that are avoidable. The early death rate from heart disease and strokes is higher than the north-west and England averages and is the fifth highest in England.

The number of people claiming sickness benefit in Salford because of mental health problems is higher than the north-west and England averages and is the sixth highest in England. The rate of hospital admissions for alcohol-specific conditions is also above the north-west and England averages and is the tenth highest in England. Reducing health inequalities and improving well-being therefore remains one of the key challenges across agencies in Salford and requires an active and co-ordinated approach.

After taking weighting factors into account, Salford PCT’s GPs have more patients to care for than the national average. The PCT estimates that we would need an additional 17 full-time GPs over and above the current 132 GP full-time equivalents to bring the average weighted GP list size down to the national average. Extra doctors would result in greater specialisation, and most practices could, for example, have GPs specialising in areas such as diabetes and heart disease. That, in turn, could lead to reduced mortality rates.

On the plus side, I should say that the number of road injuries and road deaths in Salford is relatively low and that significantly more older people are helped to live at home than the national average.

If you have not visited Salford, Mr. Illsley, you might be surprised to hear, given what I have said, that a recent Royal Bank of Scotland survey, which developed an index of lifestyle indicators and how much they cost, found that Salford is one of the best places in Britain to live—in fact, it is No. 5. Given that Salford has such good facilities, I want residents to be around and in good health for as long as possible to enjoy them and I want them to have better-than-average life expectancies.

The problem before us is complex, and we need action on a number of fronts. For example, economic and regeneration policies have a role to play, as my colleagues have said. I applaud the north-west food and health action plan, which was published at the beginning of the year. It looks at how regional agriculture and food industries can help local people to make food choices for healthier lifestyles. I was also pleased to see a recent report from NHS North West and others, which championed the role that local parks can play in improving our physical fitness and general well-being. It does not help, however, that we will lose our excellent maternity services, and we will continue campaigning to retain those services so that mothers can continue having their babies safely in Salford.

Today’s debate is more focused on health funding, however, and it is clearly about not only quality of life, but length of life. I therefore urge the Government to deliver health funding based on need, and the same goes for local authority social services. Our public and voluntary authorities will continue to work together to deliver the best for local people. If we in Salford are given additional resources, we will use them wisely and effectively. We now need to ensure that the tremendous social, environmental and economic progress that has been made in Salford is matched by progress in the health of Salford people.

I, too, congratulate my hon. Friend the Member for Wigan (Mr. Turner) on securing this important debate and enabling me to draw attention to health inequalities and health needs in Knowsley, which I represent.

Of the 26 indicators in Knowsley’s health profile, 18 are worse than the national average and one is better—it happens to relate to deaths in road accidents, although that might be connected to the low incidence of car ownership, which in turn might be connected to the fact that 29 per cent. of residents are dependent on health-related benefits, against a national average of 13 per cent. Knowsley’s figures for smoking are above the national and north-west averages. According to the statistics, we also have the worst record in England for the number of adults who eat healthily. Our male life expectancy is seventh lowest in the country and female life expectancy is fifth lowest. The main reasons for that gap in life expectancy are coronary heart disease and cancer, although we have had a proud record in that respect over the past decade, given that deaths from coronary heart disease have fallen by 19 per cent. and those from cancer have fallen by 5 per cent.

As regards the provision of funding to meet Knowsley’s health needs, I must acknowledge that the Government have recognised the problem and provided significant uplifts in funding over the past three years, and we are grateful for that. That money has been spent wisely, with sound budgeting, efficient organisation and proactive health improvement measures. Generally, our record has been good. For example, Knowsley PCT has managed the implementation of the new GP and dental contracts better than many other PCTs, and I have had little problem solving my constituents’ difficulties in that respect with the PCT’s help.

However, Knowsley is still 3 per cent. off the expected target for an area with its health profile, and that amounts to £9 million per annum. The financial strategy for the next two years assumes that we will have a 6 per cent. uplift, given Knowsley’s under-target position. If that turns out to be over-optimistic, planned investments to make a real difference to the health inequalities suffered by the people of Knowsley might have to be reduced or delayed.

Much of Knowsley PCT’s undoubted success in managing its resources is due to the synergy of its working arrangements with those of the local council. The two bodies pioneered the joint appointment of the PCT’s chief executive and the council’s director of health and social care. That has allowed for an integrated approach to health and social care and joint working to address the health inequalities agenda. That has been made possible through section 31 arrangements with the local authority, the pooling of budgets, the sweating of assets and, generally, by working together to achieve efficiencies across a wide range of services.

Although such working arrangements have contributed to the PCT’s undoubted success in addressing the health inequality agenda, its future success is vulnerable to the outcome of the comprehensive spending review. The local government formula has less weighting for social deprivation, and the local authority fears that there will be a standstill in uplift because its population is not increasing at the same rate as elsewhere in England, where there are higher levels of immigration. Clearly, that will have an impact on health care in Knowsley, as the council will have less money to invest in initiatives to help improve the health profile of the people of Knowsley.

As in many other respects, Knowsley, which is typical of the Liverpool area, has a story to tell about its attempts to address the health inequality agenda, and it can be justly proud of it. At the heart of that success story is the close working between the PCT and Knowsley council. Like other PCTs, Knowsley PCT is therefore highly dependent on the outcome of the CSR. I therefore urge the Minister to give due and particular attention to that and to ensure that Knowsley council and Knowsley PCT can continue to address health inequalities in Knowsley as well as they have in recent times.

Order. I shall call the Front-Bench speakers at exactly 12 o’clock, but I shall give two minutes to Tony Wright.

I will be very quick, because everything has been said. Clearly, this is a major issue for Labour Members, and it is significant that the Opposition Benches are empty; either Opposition Members have no health issues to raise or their areas are well funded by the Government.

All too often, we can be critical of the health service, but there has been significant investment in my constituency in the past 10 years, which has significantly improved the health of my constituents. However, there are problems with the way in which the formula is worked out. Significantly, the formula for Great Yarmouth means that we are now 3.5 per cent. below the average, but that does not tell the complete picture. Although we are underfunded, we were on target last year, but we were penalised because money was clawed back from the SHA as a result of shortfalls in other areas. In fact, our formula works out at about 6.9 per cent. below the average, which is a considerable amount of money—around £21 million—and it is something that we need to look at.

I am aware that the Government are looking at and will probably change how the formula is calculated. I do not think that there is anything wrong with the formula per se, but the funding is not coming. I would like an assurance from the Minister that there will not be changes to the formula that would change PCT funding procedures overnight.

I, too, congratulate the hon. Member for Wigan (Mr. Turner) on securing this important debate. Although at times it has seemed like a competition to decide which of the many eloquent speakers has the worst life expectancies or funding in their constituencies, I recognise the passion with which all who have spoken put their case. The title of the debate on the Order Paper is “Impact of health funding on health inequalities”. Although there is a geographical aspect to such inequalities—not, as others have demonstrated, a north-south divide—I should like to talk about gender and race inequalities.

The hon. Member for Wigan said that there is no doubt that a person’s life expectancy and health outcomes are affected by their social class at birth and by where they live, and a powerful case has been made for increased funding for areas that have the greatest need. I acknowledge that money has been spent, but we must ask whether it has been spent in the most effective way, because much of the extra Government funding has been diverted to secondary care. If we are to tackle inequality problems in the long term, we must ensure that more money is spent on the preventive health agenda and that more people have good access to primary care.

The Government recognised the inequality problem and announced that there would be 88 spearhead PCTs in 70 of the local authorities with the poorest health outcomes according to many of the indicators. The aim, which we might all agree was a worthy one, was to tackle inequalities in the long term, focus on improving life expectancy and reduce more quickly rates of premature deaths from cancer and heart disease. We might have expected to see those PCTs increase spending on public health if they were truly to address their aim, but the Liberal Democrats have analysed the public health spend in all PCTs, and unfortunately, we found absolutely no correlation between spending and the extent of need.

For example, in 2005 Lewisham was designated to receive proportionately more Government money than other PCTs to compensate for its position in the one fifth of areas with the worst health and the largest gaps between rich and poor. In fact, there was a drop in public health spending by that PCT far in excess of any other trust—14 per cent. of total PCT spending used to go on public health but the figure has dropped in recent years to 1.7 per cent. We must ask ourselves why there was such a dramatic reduction and whether it was to do with other financial pressures. Why was Lewisham PCT allowed to take its eye off the important goal of reducing health inequalities in the long term?

We also discovered that a quarter of all spearhead PCTs spent less on public health in 2005-06 compared to 2003-04, and that 26 received an increase in public health spending of less than £1,000. Will the Minister explain why that happened and why it was allowed to happen, and say something about whether we can stop it happening in future?

The hon. Member for Norwich, North (Dr. Gibson) spoke about directing money toward different budgets, and that needs to be looked at closely, because there are huge variations between trusts. The King’s Fund has analysed the national programme budget project—the NPBP—and the Government have collected data since 2003 on 21 different disease areas. There are now sufficient data to allow comparison between PCTs and to enable us to ask questions about whether they are putting funds to their best available use.

Analysis shows that the three largest shares of increase in overall PCT spend have gone to mental health, heart disease and cancer. That reflects Government priorities and no one should have a problem with it. However, the analysis also shows that there are large variations in the amounts and proportions of total budgets spent on individual disease areas by PCTs. For example, Islington PCT spends £406 per head on mental health compared to the £56 per head spent by Bracknell Forest PCT. We can argue all we like about whether people who live in Islington are any saner than people who live in Bracknell Forest, but there is also a fourfold difference in spending on cancer, a threefold difference on circulatory system diseases and an eightfold difference on musculoskeletal problems. It might be argued that the differences can be accounted for by relative needs, and there may be an evidence base for them. However, even when we adjust for those factors, we can see that the sevenfold spending gap between Islington and Bracknell Forest reduces only to a fourfold gap, which is still a huge difference in the amount spent.

The same pattern occurs around the country in relation to spending on cancer. After taking into account known population differences, the proportion of budget spent on cancer ranges from 3 to 10 per cent. of a trust’s overall budget. Local decision making cannot account for such a wide discrepancy. In-depth research ought to be undertaken so that we can compare amounts spent to outcomes, to see where money is most effectively spent and to learn lessons from that.

I shall briefly talk about gender. On average, women live five years longer, but there is a wider gap in the most deprived areas. The situation is even worse than that suggests, because general health outcomes are worse for men. For example, women contract skin cancer much more frequently, but men have a higher death rate from the disease. We are not serving men well if we allow such things to happen. Again, bettering men’s health is not necessarily down to spend; it is down to taking different approaches to tackling their problems. Men between the ages of 16 and 34 consult a GP half as frequently as women, and the outcomes are there for all to see. Asian men have a high rate of diabetes, but funding formulae do not account for ethnic mixes.

Finally, I shall comment on the Institute for Public Policy Research report that was published yesterday. It claimed that focus on choice has helped the better-off, but that to help the poorest, public services need to be personalised. Research has shown that the more affluent and better educated a person, the greater the health benefits they receive from the NHS. Care for such people is planned, but the less affluent tend to present themselves as emergencies. People in poorer areas have 20 per cent. fewer GPs per 100,000 people than in the most affluent areas in the country. Cancer death rates are 29 per cent. higher in the poorest fifth of the population.

In summary, money is important, but some of my examples show that we perhaps need to aim at other targets. We need to look at access to health services in the most deprived areas. People will not access a GP if they cannot get to one via a good travel network, and they may not be able to afford a car. All such things are relevant. Furthermore, do we have enough health visitors going into deprived areas to try to encourage families to adopt healthy living styles from the outset?

I have a final query: the Darzi review recommended polyclinics. If we centralise our health services, will that mean that in the poorest areas the poorest people, who are least likely to access existing services, will be even less likely to access them in future? There is much food for thought in what is happening, but much potential for improvement as well.

I congratulate the hon. Member for Wigan (Mr. Turner) on bringing forward this vital debate. He has long campaigned for those of his constituents who have been adversely affected by health inequalities under the present Government. I note also his work chairing the special interest group of municipal authorities within the Local Government Association, particularly with reference to its report of last month, “Caring for All: balancing fairness and stability in the funding of local services”. He slightly spoilt his introduction by, of course, attempting some party political point scoring. Perhaps I can help him. I do not know where he has been in the past few days, but recent events suggest that he may need to catch up—that in fact the Prime Minister has bottled it and ignominiously retreated from facing the electorate, having marched him and all his colleagues up the hill.

I am grateful. I am sure that the hon. Member for Wigan will agree with me that the fact that this debate is being held 10 years into the rule of a party that pledged from the outset to stand against such inequalities says something about the impact that his party has had—or rather has not had—on the country. I represent a constituency in the north-west, which is particularly well represented in the debate this morning, and that fact is important.

I also want to thank the hon. Gentleman, who is a well-known Wigan rugby league club supporter, for ceding Jason Robinson into union, without whom England might not have succeeded so well at the weekend.

Under the present Government, the relative gap in life expectancy for men has increased by nearly 2 per cent, and for women it has increased by 5 per cent. The latest figures on infant mortality confirm the previously reported trend. Despite overall improvements, the relative gap between the routine and manual groups and the population as a whole has widened over recent years, since the target baseline; and the number of sexually transmitted infections has doubled over recent years.

I will not, because we are very short of time, and the hon. Gentleman had his own chance.

We have had a wide-ranging debate in which many good points were covered. Many effectively amounted to bids, which I am sure the Minister will deal with individually when she replies.

The hon. Member for Wigan may remember a supplementary question on health inequalities that he put to the then Health Secretary, the right hon. Member for Darlington (Mr. Milburn), in 2002. The response was

“we are now in the process of reviewing the whole way in which NHS cash is distributed to local communities.”—[Official Report, 26 March 2002; Vol. 382, c. 688.]

Sadly, the current Administration, particularly as regards health policy, has rarely moved beyond the review as a piece of ongoing politicking. Last week brought us Lord Darzi’s interim report. Its release just before the end of the recess served not only to deepen the electoral chasm left by the Prime Minister’s fear of the electorate, but also to avoid Lord Darzi’s having to come to the other place. Notwithstanding the claim with which he opens his report—

“I’m a doctor not a politician”—

can the Minister tell us when the noble Lord—whose main job now, whether he likes it or not, is as an accountable politician and a Minister, and who is paid by the electorate and who accepted the job—will make his maiden speech in the House of Lords?

In his interim report, the noble Lord twice made the point that

“the Secretary of State has announced a comprehensive strategy for reducing health inequalities”.

It is true that in his statement to the House on 4 July, the Secretary of State for Health said that the matter of health inequalities is “crucial to the Government” and, referring to the Darzi review, that it was

“too important for us to wait for that review”.

He gave an assurance that the Government would

“crack on with that as an absolute priority.” —[Official Report, 4 July 2007; Vol. 462, c. 969.]

However, the Secretary of State seems to have made the announcement neither to the House nor, even more surprisingly, to the press. True, the Minister of State, the right hon. Member for Bristol, South (Dawn Primarolo) announced a web-based health inequalities intervention tool on 23 August. As far as I can see, all it does is tell spearhead primary care trusts whether to focus on smoking cessation, reducing infant deaths or preventive prescribing for cardiovascular disease. Undeniably that is of some use, but it is a far cry from a strategy. Indeed, the biggest claim that the Government made of it was that it could

“be used as part of a comprehensive local strategy to reduce health inequalities.”

Will the Minister tell us when the Secretary of State will make good on his promise of a comprehensive strategy for health inequalities?

Another review that the hon. Gentleman will be familiar with is that relating to the market forces factor, to which his constituency neighbour, the then Health Minister, and now Chief Secretary to the Treasury, the right hon. Member for Leigh (Andy Burnham) made reference in a Westminster Hall debate secured by the hon. Gentleman on 6 June. The hon. Gentleman may be interested to know that his comments in that debate were well reported by the Revolutionary Communist Party of Britain (Marxist-Leninist) on its website.

The first review referred to by the then Minister was

“an overall funding formula review that will examine the make-up of the market forces factor”,

being undertaken by the independent Advisory Committee on Resource Allocation, to be published before the allocations were made. The second was a

“specific review of the technical aspects of the MFF, which is different from the general funding formula review that ACRA has undertaken.”—[Official Report, Westminster Hall, 6 June 2007; Vol. 461, c. 138WH.]

The hon. Member for Falmouth and Camborne (Julia Goldsworthy), who was also present at that debate, said that she was informed at Christmas that the latter report was on the desk of the then Minister, Lord Warner. The Minister also made reference to the departmental consultation on payment by results, confessing that the market forces factor had been left out of the public consultation, but included in the independent, but ultimately internal, review.

Resource allocation is still being decided across the country on the basis of assumed and aggregated data in respect of deprivation and age. We increasingly have data that would allow known morbidity in a community to be the basis on which NHS resources are allocated. Can the Minister tell us, first, when ACRA’s overall funding formula review will be published; secondly, when ACRA’s specific review of the technical aspects of the marked forces factor will be published—and why it has lain so long on Ministers’ desks; and, thirdly, when the results of the departmental payment by results consultation will be published? Can she also confirm that ACRA will take account of morbidity data in its review and reflect them in the funding formula? Will the funding formula be changed to reflect local pay variation as has been done with the area cost adjustment in the local government formula?

It was the Government’s intention to publish an annual status report on health inequalities, but the first report took two years. They said in July 2003 that the Department of Health would publish an annual report on health inequality indicators, related to the health inequality targets. The first was published in August 2005 just as we were in recess. Will the Minister tell us whether she plans to reinstate that? Any Government who want properly to address the issue of health inequalities will focus not on absolute reductions, but on the relative gap between the most and the least healthy, and between the richest and the poorest. I have no doubt that the Minister will tell us all the statistics on how many cancer and coronary heart disease deaths have been prevented in the last 10 years, but will she admit that they are on a trend that was pretty well established in the latter part of the 1970s for coronary heart disease and in the early 1980s for cancer? What plans do the Government have to switch to meaningful metrics?

In “The Road to Wigan Pier” George Orwell said

“a man who drinks a bottle of whisky a day does not actually intend to get cirrhosis of the liver”.

Admittedly, that was a metaphor illustrating Orwell’s luddite attack on mechanisation, but it is a moot point for today’s debate. Only last month the Department of Health announced an increase in consumption among school-aged pupils who drink. On current trends obesity will overtake smoking within three or four years as the principal cause of avoidable death in this country, bringing concomitant diseases in its wake. The story is similar with rising alcohol consumption, drug abuse and a rise in sexually transmitted infections. Yet the Government were all too happy to watch public health budgets being plundered as PCTs tried to rake in cash to pay off a deficit of the Government’s making. A Conservative Government would give PCTs dedicated public health resources. When will the Minister show that she really cares about combating health inequalities and do that?

One issue that is not often addressed under the heading of this debate is long-term care: it is right, however, that any debate on health inequalities should look at inequity across the age range. In fairness, several hon. Members, not least among whom was the hon. Gentleman, conceded that point. Today we anticipate something of a damp squib with the comprehensive spending review, with the Government failing once more to address the scandal of people selling their houses to fund their long-term care, something that was deplored by the former Prime Minister and Member for Sedgefield in 1997. I suspect another dodge by the present somewhat enfeebled Prime Minister. That could be the only thing to trump the brazenness of the Liberal Democrats, who are still running with the headline—it is on their website if anyone wants to look—about a free personal care policy, despite their health spokesman’s confession in this very Chamber that it is a dishonest policy.

I look forward to hearing what the Minister has to say. I hope that she will give firm dates for the publication of the various reviews that I mentioned and that she will use the opportunity radically to overhaul the Government’s public health strategy, to begin combating the growth in health inequality of the past 10 years.

I congratulate my hon. Friend the Member for Wigan (Mr. Turner) and the 10 Labour MPs who have spoken so eloquently in this debate. It is timely in the parliamentary agenda.

Since the creation of the national health service, we have seen impressive social, economic and health improvements in this country. People in all regions and from every social group are healthier and living longer than ever before, and we should celebrate that, but—it is a big “but”—despite those tremendous achievements, health inequalities remain. The Government recognise the great challenge that they pose and have established the most comprehensive programme ever seen in this country to address that deep social injustice—as opposed to the previous Tory Government, who buried the Black report and ignored it.

Health inequalities are proving stubborn, persistent and resistant to change, and we are disappointed with the progress made. We have set national targets to narrow the gap in infant mortality across socio-economic groups and in life expectancy across geographic areas, but we have not seen the narrowing that we want. We knew that it would take time; we are the first Government in a generation to recognise it as a priority and choose to highlight it. We must acknowledge that every major country in the world, with the possible exception of Sweden, is struggling to resolve this intransigent problem.

There are some early signs of progress. Some 60 per cent. of the areas with the worst health and deprivation, referred to as spearhead areas, are making progress to narrow their share of the life expectancy gap by 10 per cent. by 2010. We have already seen a 27.9 per cent. reduction in the heart disease absolute inequality gap and a 12.7 per cent. reduction in the cancer absolute inequality gap between the spearhead authorities and England, but as my hon. Friend the Member for Norwich, North (Dr. Gibson) said, we must do more. The cancer reform strategy to get individuals to GPs early and the additional help in spearhead authorities are addressing the challenges.

The number of children living in absolute poverty has been halved. The number of homeless families living in bed and breakfasts has been reduced sharply, and the number of teenage pregnancies is down. We have proved that with a concentrated effort it is possible to close the gap between the affluent and the disadvantaged. If the problem is stubborn and persistent, we as a Government must be so too. We are determined to see change on inequalities.

The Secretary of State has said that tackling health inequalities will be central to the work of the Department of Health and is his priority for the NHS. He has announced that we will publish a comprehensive strategy next year for reducing health inequalities. In his interim report, published last week, my noble Friend Lord Darzi described the aims of the comprehensive strategy: to ensure that the NHS and other health services close unjustifiable gaps in health status between individuals, whatever their background, to ensure fair access for everyone to the NHS and to treat all patients fairly with high quality and good outcomes of care for all.

If my hon. Friend will allow me, there is so much to answer from those who have already spoken. I shall make progress, but I am happy to speak to him at the end.

My noble Friend emphasised in his report the need to help all members of our diverse population live longer, healthier lives, especially those least able to help themselves. What that will mean for areas with poor primary care provision is clear from that interim report. There is a strong correlation between underdoctored areas and deprivation: many such primary care trusts are also spearhead areas. A new package will provide 100 new GP practices, including up to 900 GPs, nurses and health assistants, in the 25 per cent. of PCTs with the poorest provision.

I am grateful to my hon. Friend. I exempt her from my earlier comments about no socialist being a member of our Government. The Minister has read out a series of points, all of which are self-evident and have been so for many years, yet I understand that we are spending millions more on yet another review. I urge her to lead from the front in a good socialist way and implement it without further delay.

I am always grateful to my hon. Friend for his support and encouragement. I am sure that he agrees that change must be put in context. I challenge the picture that the Opposition parties wish to paint—that nothing has been done. We are the first Government to do so, and we are making progress, but more must be done.

My hon. Friend the Member for Wigan focused particularly on resource allocation. Investment in the NHS has trebled since 1997 and now stands at £90 billion of public money. To ensure that the money reaches those in most need, the PCTs’ revenue allocation fairer funding formula takes account of deprivation, need and unmet need. We are tackling health inequalities through mainstream core funding, but my hon. Friends have quite rightly questioned some of the provision. They know that we inherited a situation in which some PCTs were getting more than they should, and it takes time to adjust that.

I give credit to my hon. Friend for the pressure under which he has kept the Government, ensuring particularly that the pace of change policy closed the gap. ACRA, the independent body overseeing the development of weighted capitation, is considering a review of how that formula works and whether it delivers the outcome that we expect. I can give my hon. Friend the Member for Great Yarmouth (Mr. Wright) the reassurance he seeks. We have not yet received ACRA’s recommendations. When we do, we will consider carefully before deciding whether, when and how the formula should be changed, for the reasons that he mentioned.

Under the fair funding formula, Ashton, Leigh and Wigan PCT received an allocation of £449.1 million. During the two-year period 2006-08, it has benefited from a total resource increase of £74 million, or 19.7 per cent., which is greater than the average national increase. It has also received £4.8 million in additional funding through allocations from the £553 million. Under the pace of change process, we have continued to reduce the gap.

To follow the comments made by my hon. Friends, we as a Government have faced up to the problems of health inequalities, but we must now act. Improving the health of the nation means ensuring that those with the poorest health improve the fastest. I congratulate my hon. Friend on securing the debate. I listened carefully to the comments and representations made, and I shall take them back with me to the Department of Health.