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Health Inequalities

Volume 561: debated on Tuesday 23 April 2013

It is my great honour, Dr McCrea, to serve under your chairmanship.

It is crucial that everyone in this country, regardless of income or location, should have access to the same level of health care; social background should not be a determinant of health. Currently, people who live in the poorest neighbourhoods will die on average seven years earlier than those in the richest neighbourhoods, and the average difference in disability-free life expectancy is 17 years between the richest and the poorest. We should be concerned about health inequalities existing on that basis, because it shows not only that we are not all in this together but that people throughout the country are unnecessarily and unfairly suffering because of their social background.

I congratulate the hon. Gentleman on securing the debate and on the work that he has done on the subject over the years. He was talking about life expectancy; in Medway, which covers three parliamentary constituencies, the difference in life expectancy between the most deprived 10% and the least deprived 10% is 9.6 years. He talked about all being in this together, but that 9.6 years did not arise in the past three years; that difference in life expectancy was present for many years under previous Governments as well.

I thank the hon. Gentleman for his important intervention, but we are not present as part of the blame culture. We are not debating what happened 10 years ago; we are talking about learning from the past and about how best to improve services. I am sure that the Minister will answer such questions, but I assure Members that I am not here to defend or not to defend, but to raise the issue, and to talk about what is happening in today’s terms and about why, what and how to improve.

The previous Labour Government committed themselves to reducing health inequalities. They made progress in meeting targets on infant mortality and headline indicators for life expectancy as a result of early intervention programmes and initiatives such as Sure Start. Reducing health inequalities is not only fair but makes economic sense.

I am staggered by the hon. Gentleman’s statement about the previous Government making progress. The gap in life expectancy between deprived and wealthy areas widened under Labour, and there were more GPs per head of population in wealthy, healthy areas and fewer in poor, unhealthy areas. Can he explain why?

We are trying to avoid getting into the blame culture or blaming the previous Government. I am sure that that gap of 9.6 years or whatever was an improvement on previous years.

It is unnecessary to debate that. My point concerns what is happening today; I am not rude, arrogant or avoiding the issue, but the debate is about what is happening in the system, and the purpose is to find out what steps the Minister can assure us are being taken to improve the situation.

It is worth putting it on the record that the cross-party Public Accounts Committee, chaired by a Labour Member, the right hon. Member for Barking (Margaret Hodge), looked at how in 1997 the Government were to put health inequalities at their heart and at setting targets in 2004, but those targets were not met. It is remiss of the hon. Gentleman to come to the Chamber today and to talk about the previous Government making progress when the gap in life expectancy increased, the GPs were in the wrong place and a cross-party Committee chaired by a Labour Member is saying that they failed to meet their targets.

I thank the hon. Gentleman for correction on that and I am sure that there are many other areas we could cover, but given the time available I want to complete my way of looking at the subject. He will have the opportunity, through the Minister, to talk about those questions.

Reducing health inequalities is not only fair but makes economic sense, as I said. Reducing such inequalities will diminish productivity losses from illness and cut welfare costs. My constituency is a diverse area with a high rate of deprivation and with about 19,100 children living in poverty. The impact on the health service is noticeable. The mortality rate is a lot higher than average, especially in the most deprived wards of the constituency. Diseases such as diabetes, coronary heart disease and tuberculosis are much more prevalent than in the rest of the country, and they are unfortunately directly related to the social inequalities in the area.

The coalition Government have shown a lack of commitment to reducing health inequalities, whether through their health policies or their socio-economic policies which will increase inequality between the richest and poorest. Through the Health and Social Care Act 2012, the Government have increased competition and opened up NHS services to tender from the private sector; if the section 75 regulations are pushed through the House of Lords tomorrow, patients with complex conditions that are perceived as less profitable will not be as readily treated by private providers. On top of that, the increase in private patients in hospitals after the lifting of the private bed cap will mean that access to beds for those who cannot afford private services will be restricted, increasing waiting times. In my own constituency, Ealing hospital will be downgraded and the A and E closed. Some of the poorest and most vulnerable people will therefore see the services that deal with their specific needs closed, and they will have to travel great distances, which they cannot afford to do, to get treatment.

Recent reviews and evidence have proved the link between health inequalities and wider social determinants such as income, employment, welfare and housing. The Government’s record gives us poor hope of progress in reducing those inequalities: fuel and food prices have gone up; increases in wages are less than those in the consumer or retail prices index, leaving people out of pocket every month; child poverty is increasing; homelessness is set to rise after the recent welfare cuts; and, as announced last week, unemployment is rising again. Those affected will only be more vulnerable to health difficulties, increasing the inequality between the richest and poorest in our society.

The Government need to commit themselves to reducing health inequalities to ensure that social background does not determine lifespan and quality of life. The previous Labour Government took some first steps towards reducing the health gap between the richest and poorest, but that progress is likely to be thwarted by the Government’s unfair policies. Can the Minister provide some reassurance from the Government that they are committed to reducing unfair and harmful health inequalities during their term?

The Parliamentary Under-Secretary of State for Health (Anna Soubry): It is a pleasure, Dr McCrea, to serve under your chairmanship. I congratulate the hon. Member for Ealing, Southall (Mr Sharma) on securing the debate and raising this important issue, although this is only a half-hour slot.

The hon. Gentleman said that he was keen to learn from the past. That is an admirable aim but, unfortunately and with great respect, he has rose-tinted glasses when looking back at the previous Government’s record. I will look at that record with no rose tint. The simple truth has been identified by my hon. Friend the Member for North East Cambridgeshire (Stephen Barclay), and despite the doubtless very best intentions, health inequality under the last Government got worse, notwithstanding their claim to have made it some sort of priority and to have put more money into the NHS.

The last Labour Government took more than 10 years to introduce even basic known measures such as smoking cessation programmes in deprived communities, although the science and evidence base was clear. Will the Minister assure the House that the Government will not say one thing and do another on health inequalities, but will follow the science?

I can say that absolutely. The hon. Member for Ealing, Southall asked whether the Government are committed to reducing health inequalities and making the sort of progress that we did not see in 13 years of the previous Government. I assure him that it is not just a question of blind intention, but an absolute fact that we have already done it.

[Interruption.] I am making a noise because I am removing the script of my speech. I am not good at following a script from my officials. They are extremely helpful, and it sometimes causes them concern that I go off script and speak off the cuff.

I am familiar with the Health and Social Care Act 2012. What the hon. Gentleman either does not know—this is not a criticism—or may have forgotten is that, for the first time ever, there is a statutory duty, not just on the Secretary of State, but throughout the NHS, to improve health inequalities. It is not a question of targets, which have not always delivered the right outcomes, and Mid-Staffordshire NHS Foundation Trust is a good example, as was identified in the Francis report. That duty is statutory so the Secretary of State and all those involved in the NHS must deliver, and the Secretary of State must give an annual account of how his work in leading the Department of Health and being the steward of the NHS in England has delivered a reduction in the sort of health inequalities that we all understand. That is there in law, but in 13 years in government, the hon. Gentleman’s party failed to do that.

I am not disputing the matter and, as I said at the beginning of my speech, I do not want a blame culture or to say what happened during those 13 years, but I ask the Minister to join me in my constituency on Saturday when thousands of people will march from Southall to Ealing. At the last march in September, there were more than 20,000 people, and we expect more this time. She will then know whether people believe that services have improved or got worse.

I am grateful to the hon. Gentleman but, with great respect, he does not understand that reducing health inequalities is not simply about saving an A and E department. I hope that, when the hon. Gentleman is marching on Saturday, he will remonstrate with anyone who has a banner saying “Fight the NHS cuts”. Whenever anyone looks at reconfiguration, they do so on the basis of how to make the service better.

I am sure that the Minister is aware that, on reconfiguration, bodies such as the Royal College of Surgeons support specialised centres, because they save lives. The evidence from stroke services in London is that reconfiguration is saving around 500 lives a year.

May I draw the Minister’s attention to the fact that, at the end of the last Labour Administration, only 4% of the NHS budget was being spent on prevention? It is all very well for the hon. Gentleman to join marches, but prevention is far more helpful from a value-for-money perspective than treating things when they go wrong.

I am very grateful for that intervention. My hon. Friend makes the point more ably than I can that much of the great work to reduce health inequalities is not about whether there is an urgent care centre or an accident and emergency centre within 500 yards or 5 miles of where someone lives. Work on public health is critical, and that is why I am so proud that this Government have increased the amount of money available to local authorities, which now have responsibility for delivering public health. They had that historically and we have returned that power to local level. That is important in the delivery of improvements in public health. This Government’s view is that local authorities, as in the hon. Gentleman’s constituency, know their communities better than Whitehall does. In the delivery of key and important work on public health, it is right and proper that local authorities have that responsibility. They, too, have a statutory duty to deliver on health inequalities. That runs through all their work of looking after the public’s health, but, most importantly, addresses those very factors that cause the sort health inequalities of which we are all conscious. For example, there is a clear demographic link between smoking and diabetes.

If the hon. Gentleman goes to Leicester, he will see the work that is being done there and in Leicestershire with the clinical commissioning groups—the GPs are now doing the commissioning—working for the first time with the local hospital and looking at a whole new way of delivering a better pathway not just of care, but of early diagnosis and prevention, linking those up in a way that has never been done before in the NHS. If he sees those examples, far from criticising the Government or having doubt about our commitment to health inequalities, he will take the opposite view.

If the hon. Gentleman needed yet further proof of the great work that can be done under the new way of delivering public health and commissioning in the NHS, he could do no better than take a trip to Rotherham in Yorkshire. I went there to see its fantastic work in tackling obesity. Obesity is a clear issue of health inequality and Rotherham has taken a totally joined-up approach. GPs are working with dieticians, schools and planners, with the local authority at the heart. They are all coming together to deliver a considerably better strategy, with real results in tackling the problems in that area.

On funding, it is important for the hon. Gentleman to understand that we have increased the amount of money that is available. It is now ring-fenced, on a two- year deal, so that real security and certainty is given to those local authorities. In some areas, we have increased up to 10% the money that is available to spend on public health.

I completely share the Minister’s opinion about an approach where local authorities know what is in their best interests—for example, in relation to obesity in Medway, which has one of the highest recordings above the national average for obesity. However, I want to raise another point with the Minister. On diabetes and organ transplants, certain parts of the community—or certain parts of minority communities—are more likely to be affected. Will there be a national strategy that covers and supplements what is going on locally, because these are national issues that affect minority communities throughout the country?

I am grateful to my hon. Friend for making that point. The subject of diabetes—type 2 in particular—and the clear link to obesity and being overweight is something about which I am beginning to have a passion, because I can see the great work that can be done. We have just done a cardiovascular strategy. It is a call for action about mortality, and we know that cardiovascular disease work sits within that, and that cardiovascular work—I am getting very worried, Dr McCrea, because I am beginning to sound almost as though I am a health professional, when I am nothing more than a simple hack criminal barrister, rather like my hon. Friend.

The point, however, is that we know that if we look at diabetes, many other boxes are ticked in improving the lot and the health of our population. Certain parts of our population, in particular, have suffered from health inequalities, and my hon. Friend makes a very good point about some of our communities—in the Asian community, there is a great prevalence of type 2 diabetes, as there is in the Afro-Caribbean population. If we look at diabetes prevention, earlier treatment and diagnosis, and then proper treatment and good outcomes, other boxes are ticked—for example, obesity and being overweight, and all the other things that often flow from diabetes, such as the link with cardiovascular disease and so on. My hon. Friend makes a very good point about how a local authority beginning really to drill in and target a particular illness or disease can have many beneficial spin-offs in the manner that I have described.

The Government have established a comprehensive measurement system designed to measure not only overall improvement, but, in particular, inequalities. The NHS outcomes framework—I know that these words do not trip off the tongue and that they may be lost on the majority of completely normal people, but they are important documents—forms the basis for measuring progress on delivering improved results for patients and reducing health inequalities. The NHS England business plan commits to assessing health inequalities across a range of dimensions in the NHS outcomes framework, and those important documents guide our clinicians, the commissioners, and everybody involved in ensuring that we live longer, healthier, and happier lives. That exercise may reveal important health inequalities that have not previously been evident. The public health outcomes framework includes an overarching aim to reduce differences in life expectancy and healthy life expectancy between communities, through greater improvements in more disadvantaged communities. Public Health England will regularly publish data for the indicators, including breakdowns by key equality and inequality characteristics to enable monitoring to help focus action where it is needed.

I am looking forward to the time when we begin to publish, by local authority, the outcomes in each local authority on such things as the stopping of smoking, and the work that is done on the abuse of alcohol. Invariably, we gather that information, but when we start to publish it and put it in the public domain, Members of Parliament, local councillors and members of the public will all have access to it, and they will be able to see how their local authority is performing. We will not try and trick anybody and we will not be unfair, but we will ask people to compare like with like. We make it clear to local authorities that they do not all start from a level playing field, because many of them, unfortunately, are inheriting public health policies that were not some of the best. Therefore, we will recognise that—it is one of the legacies left over from the previous Administration. However, because people, GPs, and everybody involved in the delivery of health, including councillors and Members of Parliament, will have public access to such information, I have no doubt that that will begin to drive a real desire to reduce health inequalities.

I mean no disrespect to the hon. Member for Ealing, Southall, but I know the previous job of my hon. Friend the Member for Gillingham and Rainham (Rehman Chishti) and he, like me, knows that there is no better grit in the millstone among professionals than when comparisons are made about who has a better set of results. There is always good, healthy competition between professionals. We have seen that in the past when we published—I am not going to try to pretend that I can remember what it is, and if I say what I think it is, Dr McCrea, you can bet your bottom dollar that it will be wrong, but I know that in the past we have published the outcomes of particular procedures and surgery, and that it has improved the outcomes to everybody’s benefit when there has been a bit of healthy competition between professionals. That is what we intend to do by publishing the statistics on public health outcomes by local authorities, so that everybody can see what is out there. We saw it in recycling rates. Publishing information did exactly what we hope it would—it upped everybody’s game, and that is one of the reasons why we will do it.

To conclude, we have created a new health system that makes tackling health inequalities core business, underpinned by new legal duties, measurement and assessment. The local autonomy that we have given to our CCGs and our health and wellbeing boards will enable them to take focused action that meets the needs and aspirations of their populations, concentrating on the groups that experience the worst health inequalities. I hope that the hon. Member for Ealing, Southall is now in no doubt about what has been done.

Tackling health inequalities is a key priority for the Government, and it supports the wider focus on fairness and social justice. I know from a radio interview that I gave on Friday—on the “Today” programme on the BBC—that Professor Marmot, who wrote his brilliant report on health inequalities, has already recognised how important it has been that we have made this a statutory duty. He has praised much of the work that this Government have done—I have to say, in stark contrast to the previous Government, of which the hon. Gentleman has been a firm supporter.

Our approach is to design a system that empowers those at a local level to take action on inequalities, with a strong focus on commissioning quality services and on improving the health of the poorest, fastest.

Question put and agreed to.

Sitting adjourned.