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Health Inequalities

Volume 482: debated on Tuesday 4 November 2008

4. What research his Department has undertaken into the reasons for health inequalities; and if he will make a statement. (232533)

The Government’s programme for addressing health inequalities is informed by a wide evidence base on the complex underlying factors, as highlighted in the Acheson Report and, more recently, the World Health Organisation report “Closing the Gap in a Generation”, which was published in August and which the Government welcome and support.

I thank my right hon. Friend for his answer. I know that he agrees that the postcode lottery in health has to be stopped and we have to move forward. For example, in Scotland we have twice the waiting lists that people have in England. Can he assure me that such inequalities, and the problems that we have in the regions in general, can be looked into to ensure that best practice is taken forward and that the money that is supplied will go to where the needs are greatest?

My hon. Friend is right to draw attention to this crucial issue, which we regard as a huge priority. The Department of Health alone cannot tackle these issues of health inequality: we need concerted action across government involving education, planning, local government and housing. We are therefore working with colleagues in government. I suggest that the introduction of 113 new GP practices in under-doctored areas—the 25 per cent. with the least provision of GP services—goes a huge way towards making our contribution to tackling this crucial problem.

What would be the impact on health inequalities of permitting people to buy their own medicines where they were not available while keeping their NHS treatment?

I shall make a statement on precisely that point later on. The right hon. Gentleman reminds me—he is interested in health inequalities—that between the ’70s and the ’90s the situation on health inequalities got worse. For men of working age, comparison of the mortality rate of the unskilled with that of professionals shows that it was twice as high in the 1970s, and it ended up three times as high in the 1990s. Whatever we do, we will do much more to tackle health inequalities than the Government of whom he was a member.

Halton has the worst rate of early deaths from cancer in England, and life expectancy is three years less than the national average. A lot of work is being done locally to improve things, but I am particularly concerned about teenage health. The chief medical officer has said that poor health in teenagers can last a lifetime. Can my right hon. Friend tell me what the Government are doing to address that concern, which relates to a group that is particularly difficult to reach?

My hon. Friend is right about the need to focus on people in this group, who sometimes miss out because we are focusing on children’s and adults’ services. That transition period is very important. The biggest contribution is made by public health. This is about smoking—there are still far too many youngsters starting to smoke at age 16 and even younger. The Minister of State, my right hon. Friend the Member for Bristol, South (Dawn Primarolo), proposes to tackle that through a number of measures, including not allowing cigarettes to be sold in packs of 10. That will make a big contribution. We must also do more to tackle the problems of excessive alcohol consumption among children in their teenage years. That will be the subject of a report in the near future.

What do I say to those of my constituents who truly believe in a national health service, but who have relations in Scotland who get treatments and drugs that they cannot get in England?

The hon. Gentleman should say that that is not true. There are no drugs available in Scotland that are not available in England. It is true that the Scottish system, via the Scottish Medicines Consortium, works more quickly than the one in England, but that is because it takes its lead from the National Institute for Health and Clinical Excellence, by and large, and it does not have a consultation process. It does not consult the public on its decisions. The hon. Gentleman, as a Member for an English constituency, can take heart from the fact that the accusations he hears in his local Dog and Duck are quite unfounded.

I am delighted that Fiona and Julian Keen in my constituency have opened a brand-new NHS dental surgery that is well supported by the local PCT, but does the Secretary of State recognise that two years on from the new dental contract, access to NHS dental services is still inadequate? What will he and the Government do to ensure that dental health inequalities are dealt with urgently?

My hon. Friend may know that a very important report on dental care has recently been published by the Health Committee, whose Chairman is in his place—[Interruption.] And of which my hon. Friend is a member—I was about to say that. A number of points in it are really important, not least the recitation of the history of the problem, which points out how bad dentistry was in the 1990s, and the need to introduce a new contract. The report raises issues that we need to look at. I believe that fluoridation is a major force in tackling dentistry inequalities, and a dentist said to me recently, “It gives poor kids rich kids’ teeth.” That is why the consultation that is going on in the south-west and will soon take place in the north-west is so important.

In tackling health inequalities, particularly regarding access to new drugs and treatment, does the Secretary of State agree that we should have a system that is far more transparent about NICE decisions, so that it is more accountable, and that the models used in appraisal decisions should be published?

We need greater transparency in all aspects of the process. The greatest transparency—I shall say more about this later—comes in the decisions of PCTs’ exceptional circumstances committees where NICE has not ruled on a drug, and where there is a lack of transparency and consistency. That is the major problem, and we shall consider some of the issues relating to NICE that arose from a recent case. In a sense, the matter the hon. Gentleman raises is second on the agenda.

May I urge my right hon. Friend to press the Treasury to release the moneys that have been allocated to the NHS in the current comprehensive spending review round? Will he work to ensure that the ACRA—Advisory Committee on Resource Allocation—recommendations that will be released shortly are implemented as quickly as possible so that all PCTs will have the resources necessary to eradicate health inequalities in our country?

The situation on allocations is that we are waiting for the pre-Budget report. We can then issue the operating framework along with the ramifications of the Darzi review, and that is when the ACRA report that my hon. Friend mentioned, which is crucial in tackling health inequalities, will become part of the process. He will not have to wait long; it will certainly happen well in advance of the beginning of the next financial year.

While my party of course agrees that reducing health inequalities must be a key priority, the Government’s record has not been good, despite what the Secretary of State has said. The gap in life expectancy and infant mortality has increased during the past decade, and we have the highest health inequalities in Europe. Does he agree that there can be no reduction in health inequalities without improvement in public health driven by local control of public health budgets, accurately reflecting communities’ needs and tackling social and environmental issues, overseen by locally appointed directors of public health?

I do not blame the hon. Gentleman personally, but I wonder where we would have been on health inequalities if the Black report, which was commissioned in the late 1970s but reported in the early 1980s, had been implemented. Three hundred copies were published on a bank holiday Monday, with a foreword by the then Conservative Secretary of State, Patrick Jenkin, stating that everything in the report was basically rubbish. [Interruption.] They are chuntering on the Conservative Front Bench, but they know that health inequalities worsened between 1979 and 1997. The hon. Gentleman might like to know that, since then, in eight years, the health of the poorest and most deprived in our nation has now reached the level that the rest of the population attained eight years ago. Infant mortality is down and life expectancy is up in spearhead areas. That shows what one can do with a Government who genuinely set tackling health inequalities as a priority. The Conservative party did nothing—indeed, we went backwards during their 18 years in government.