Cookies: We use cookies to give you the best possible experience on our site. By continuing to use the site you agree to our use of cookies. Find out more
House of Commons Hansard
x
Reducing Health Inequality
24 November 2016
Volume 617

[Relevant document: Second Report of the Health Committee, Public health post-2013, HC 140.]

The edit just sent has not been saved. The following error was returned:
This content has already been edited and is awaiting review.

There are 11 Back-Bench contributors to this debate. Will Members bear that in mind, in order to give everybody a good chance of having equal time?

The edit just sent has not been saved. The following error was returned:
This content has already been edited and is awaiting review.

I beg to move,

That this House calls on the Government to introduce and support effective policy measures to reduce health inequality.

In her first speech at Downing Street, the Prime Minister referred to the “burning injustice” of the difference in life expectancy between the richest and poorest in our society, and to her determination to tackle it. The purpose of this debate is to try to assist the Government in making that a reality, but I also urge her to look at the gap in healthy life expectancy. Based on Office for National Statistics data from 2012-13, the healthy, disability-free life expectancy of a woman born in Tower Hamlets is 52.7 years of age, while that for a woman born in Richmond upon Thames is 72.1 years of age. That is a gap of about 20 years. The social gradient for disability-free life expectancy is even greater than that for mortality. I ask the Under-Secretary of State for Health, my hon. Friend the Member for Oxford West and Abingdon (Nicola Blackwood), to consider the issue not only as one of social justice, but as one that adds hugely to NHS costs and to economic costs more widely. There is a compelling economic and social justice case for tackling it.

What should the Minister do? In a nutshell, she should follow the evidence and start immediately, beginning with the very youngest in society—in fact, she should start with them even before they are born—and take a whole life course approach, following all the wider determinants of health. She should also take a cross-Government approach, with leadership at the highest level of the Cabinet. She needs to take the long view—many of the benefits will become evident in 20 or 30 years’ time—while not ignoring the fact that there will also be quick wins. She needs to look at everything that needs to be done to tackle the situation.

I hope that this will be a consensual debate. I congratulate the Labour Government on the work that they did to tackle health inequalities, which is starting to pay dividends. I also pay tribute to Sir Michael Marmot for his groundbreaking work; the blueprint that he set out in 2010 holds true today and it should be the basis of everything that we do. It is about giving every child the best possible start in life and allowing people of all ages to maximise their capabilities and exercise control over their lives. It is also about fair employment and good work, healthy environments and communities, standards of living and housing.

It is about preventing ill-health as well, and that is what I want to address, because I know that many Members across the House will speak with great expertise about the wider determinants of health. Tackling the issue starts long before people come into contact with health services, but that is still an enormously important part of tackling health inequalities. As Chair of the Health Committee, I will focus on those aspects.

On preventing early deaths, we need to look at lifestyle issues, including smoking and obesity, and at preventing suicide, which is the greatest single cause of death in men under the age of 49. Public health plays a critical role. The “Five Year Forward View” called for a radical upgrade in prevention in public health. Cuts to public health budgets are disappointing and will severely impact on the Government’s ability to tackle health inequalities. The Association of Directors of Public Health surveyed its members in February and found that the cuts to the public health budget were affecting issues such as weight management, drugs, smoking cessation and alcohol, which are key determinants that we need to tackle. In my own area, part of which covers Torbay, cuts of about £345,000 to council public health budgets will result in the decommissioning of healthy lifestyle services. Those budgets affect education and active intervention, and support a network of fantastic volunteers. I regret that those cuts to public health are going ahead, and call on the Government to stop them.

I want to tackle a few key areas. First, smoking is still the biggest cause of preventable death in the United Kingdom. Every year, 100,000 people die prematurely as a result of smoking. In her closing remarks, I hope that the Minister will update the House on the tobacco control plan.

The edit just sent has not been saved. The following error was returned:
This content has already been edited and is awaiting review.

About 25 years ago I took an interest in how many death certificates mentioned smoking, and the answer was four. The figure may be larger now, but we should encourage medical practitioners to say that the person had been an active smoker, even if it was not the primary cause of death, so that at least people can become more aware of the issue.

While I am talking about this, I will mention two other things, which my hon. Friend may be going to cover. One is nutrition at the time of conception, and the second is that we should learn the lessons of how we cut the drink-driving deaths, which was not by public programmes, but by people doing the things that actually made a difference—that cut down the incidence and cut down the consequences and cut down the deaths.

The edit just sent has not been saved. The following error was returned:
This content has already been edited and is awaiting review.

Those are extremely important points. The Government can introduce policies and make sure that there are levers and incentives in the system to make that happen. The drink-drive limit is a very important example.

We are not likely to make a difference to the gap in disability-free life expectancy without tackling smoking, which is a key driver for health inequality and accounts for more than half of the difference in premature deaths between the highest and the lowest socioeconomic groups. Without tackling it, we will not make inroads.

I would like briefly to touch on obesity and on the Government’s obesity strategy, which the Health Committee has looked at. To put the matter in context, the most recent child measurement programme data show us that 26% of the most disadvantaged children leave year 6 not just overweight but obese, as do 11.7% of the least deprived children. Overall, of all children leaving year 6, one in three is now obese or overweight. The situation is storing up catastrophic lifetime problems for them, and we cannot continue to ignore that.

In our report, the Committee called for “brave and bold action”. Although I really welcome many aspects of the childhood obesity plan—such as the sugary drinks levy, which is already having an impact in terms of reformulation—it has been widely acknowledged that there were glaring deficiencies and missed opportunities in the plan.

I would like to have seen far greater emphasis on tackling marketing and promotion. Some 40% of food and drink bought to consume at home is bought under deep discounting and promotion, and that is one of the potential quick wins that I referred to. We often focus in this debate on what people should not do, and this is an opportunity to look at what they should do. Shifting the balance in promotions to healthy food and drink would have been a huge opportunity for a quick win, because one of the key drivers of this aspect of health inequality is the affordability of good, nutritious food. This would have been an opportunity to tackle marketing and promotion, and I urge the Minister to bring that back into the strategy. I also urge the Government to extend the sugary drinks levy to other drinks, including those in which sugar is added to milky products, because there is no reason why it should be necessary to add sugar to such drinks.

I also welcome the mention in the plan of the daily mile, which has been an extraordinary project. I have met Elaine Wyllie, who is one of the most inspirational headteachers one could meet, and she talked about the strategy and about how leadership from directors of public health makes a real difference. I hope that the Minister will update the House on how that will be taken forward. We should think not just about obesity, but about physical activity and health promotion, and about the benefits that they could bring to all our schoolchildren.

The Health Committee stressed in our report the importance of making health a material consideration in planning matters when money is so restricted. I do not think that to do so would be a brake on growth; it would be a brake on unhealthy growth, and it would give local authorities the levers of power when they are making licensing decisions and planning decisions for their communities. That is something that Government could do at no cost, but with enormous benefit.

The Health Committee is actively considering how we reduce the toll of deaths from suicide. The Samaritans have identified that men living in the most deprived areas are 10 times more likely to end their life by suicide than are those in the most affluent areas. Many factors contribute to this—economic recessions, debt and unemployment—but when we try to tackle health inequality, we will not make the inroads that we need to make unless we look at the inequality in suicide, particularly as it affects men. Three quarters of those who die by suicide are men. I hope that the Minister will look carefully at the emerging evidence from our inquiry as the Government actively consider the refresh to the strategy, and that they will do so at every point when they look at how to tackle health inequality.

I would like the Minister to look at the impact of drugs and alcohol on health inequality. The fact that there are 700,000 children in the United Kingdom living with an alcohol-dependent parent is a staggering cause of health inequality, which has huge implications for those children’s life chances and for the individuals involved. Again, alcohol has a deprivation gradient; the two are closely linked.

There is evidence about what works, and we have had encouraging news from Scotland. The Scottish courts, I am pleased to say, have ruled that minimum pricing is legal, although I am disappointed that the Scotch Whisky Association has yet again taken the matter to a further stage of appeal. As soon as those hurdles are cleared, I think it would be a great shame if England undermined the potentially groundbreaking work being done in Scotland by failing to follow suit and introduce minimum pricing at the earliest possible opportunity; if we failed to do so, people would be able to buy alcohol across the border.

The edit just sent has not been saved. The following error was returned:
This content has already been edited and is awaiting review.

I thank the hon. Lady for giving credit to the Scottish Government for what they have done on minimum unit pricing. I reiterate what she has said: it is disappointing that the matter has been taken to appeal yet again. Does she agree that there is a lot to look at from Scotland in terms of the smoking ban, which England then took up?

The edit just sent has not been saved. The following error was returned:
This content has already been edited and is awaiting review.

I congratulate the Scottish Government. It does seem to be the case that where Scotland leads, England will eventually follow. Scotland is particularly good at following the evidence, and I call on us to do likewise. I am particularly concerned that the benefits that will come about when Scotland introduces minimum pricing will be undermined if we do not follow suit here, so I call on the Government to do so as soon as possible.

In summary—I know that many other Members wish to speak—there is a huge amount that we can do, and not all of it has a cost. I urge the Minister, in summing up, to look at all the possibilities. I urge her to stick with the Marmot agenda and to take a cross-Government approach, but to make sure that there is leadership at the highest level. The Prime Minister’s words in Downing Street were hugely encouraging. The Health Committee calls on the Prime Minister to appoint somebody at Cabinet level to take overarching responsibility for health inequalities and to put those fine words into action.

The edit just sent has not been saved. The following error was returned:
This content has already been edited and is awaiting review.

I rise to express my enthusiastic support for the work of the Health Committee under the superb leadership of the hon. Member for Totnes (Dr Wollaston). I also pay tribute to the Prime Minister for her description of health inequalities as a “burning injustice” and for placing the issue at the top of her agenda, which was virtually the first thing she did as Prime Minister of this country.

This is an unusual debate. Usually in this Chamber, Back Benchers press the Government to take something on as a priority, but this is more of a top-down issue. The need to tackle health inequalities has been forcefully expressed by the Prime Minister, and through this debate we are trying to translate those words into effective action. For those of us who have grappled with the nuts and bolts of trying to tackle the obscenity—that is what it is in the 21st century—of health inequality, the Prime Minister’s words were, as the hon. Lady said, enormously encouraging, because they demonstrated the leadership that the issue requires if the awful statistics are to be properly addressed.

I want to set the matter in its historical context to demonstrate the difference in approach that spans the 37 years between the appointments of Britain’s first woman Prime Minister and its second. Although health and life expectancy improved dramatically for everyone following the creation of the NHS in 1948, there was a strong suspicion by the 1970s that persistent health inequalities existed and that they were defined largely by social class. There was, however, an absence of easily understood statistical evidence on which to base a clear assertion. In 1977, the then Health Secretary, David Ennals, commissioned the president of the Royal College of Physicians, Sir Douglas Black, to chair a working group that would report to Government on the extent of health inequalities in the UK and how best to address them. The report proved conclusively that death rates for many diseases were higher among those in the lower social classes. Stripped bare, it was the first official acknowledgment that the circumstances into which a person was born would largely determine when they died. That remains the thrust of the argument expressed by the Health Committee’s report, except that it has quite rightly added the new dimension, which was highlighted by the Marmot indicators of health inequalities in November 2015, of the difference made by the number of years spent in good health. There is an extraordinary gap between the most and the least disadvantaged of almost 17 years.

By the time the Black report was published, a new Government had been elected. They displayed their enthusiasm for tackling health inequalities by reluctantly publishing fewer than 300 copies of the report on an August bank holiday Monday in the depths of the summer recess. In his foreword to the report, the new Health Secretary could not even raise the enthusiasm to damn the report with faint praise; he simply damned it and virtually ignored it, and that remained the case for 18 years.

This is important because people assume that health has improved for everyone since the 1940s—it has, by and large—yet during those 18 years, many of the problems that Black highlighted actually got worse. For instance, in the early 1970s, the mortality rate among young men of working age in unskilled groups was almost twice as high as that among those in professional groups; by the early 1990s, it was three times as high. The most awful statistic—this began to emerge in the 1980s—was that the long-term unemployed were 35 times more likely to commit suicide than people in work. It would be inconceivable today for a Health Secretary to be as dismissive of an issue that is so critical to the life chances of so many.

We are also more aware today than we were then that healthcare is only part of the problem. Indeed—the Minister has a difficult job—it is a minor part: the proportion has been calculated at between 15% and 25%. The epidemiologist Professor Sir Michael Marmot, the world’s leading expert on this subject, has established the social determinants of health. The Acheson report of the late 1990s explained:

“Poverty, low wages and occupational stress, unemployment, poor housing, environmental pollution, poor education, limited access to transport and shops”—

and the internet—

“crime and disorder, a lack of recreational facilities…all have an impact on people’s health.”

Beveridge’s five giants—disease, want, ignorance, squalor and idleness—were a more pithy and poetic way of describing the problem. Beveridge’s brother-in-law, the historian and Christian socialist R. H. Tawney, set the template that we should follow. He said the issue was

“not…to cherish the romantic illusion that men are equal in character and intelligence. It is to hold that…eliminating such inequalities as have their source, not in individual differences, but in its own organization”.

The Marmot report, which I commissioned as Health Secretary in 2008 to inform policy from 2010 onwards—unfortunately, the electorate decided that we would not be in office to carry this out—recommended six policy areas on which we should focus: the best start in life; maximising capabilities and control; fair employment and good work; a healthy standard of living; healthy and sustainable places and communities; and a strengthened role for and provision of ill-health prevention. Marmot advised that those six areas should be focused on with a scale and intensity proportionate to the level of disadvantage, which he called “proportionate universalism”. The coalition Government accepted all Sir Michael’s recommendations. However, they responded with a policy— “Healthy Lives, Healthy People”—in which the focus was on individual lifestyle and behavioural change. That, as Sir Michael has pointed out, is only one facet of the problem, just as the NHS is only one part of the solution. Moreover, the only piece of cross-Government co-ordinating machinery, the Cabinet Sub-Committee on health, was scrapped in 2012.

The Health Committee’s report on public health and today’s debate, together with the Prime Minister’s pledge, give us a fresh opportunity to capitalise on the brilliant work done by Sir Michael Marmot and his Institute of Health Equity at University College London, and on the political consensus that I am pleased to say now exists on this issue, by forging a fresh and dynamic response across the Government to tackling health inequalities. One of the Committee’s recommendations, as has been mentioned, is that a Cabinet Office Minister should be given specific responsibility for leading on this issue across the Government. I have a more radical suggestion: the Prime Minister herself should take personal responsibility for this issue. The Prime Minister is also the First Lord of the Treasury and Minister for the Civil Service, and previous Prime Ministers have taken on other ministerial positions—Wellington was also Foreign Secretary, Home Secretary and Colonial Secretary, and Churchill was Prime Minister and Defence Secretary. It would set a wonderful example if the Prime Minister followed up her words by saying, “I’m going to lead on this. I’m going to chair the cross-Government Committee that tackles health inequalities.” That level of leadership is needed, because only then will there be meaningful cross-departmental work to tackle these inequalities.

I echo the Health Committee’s view that devolving public health to local authorities was the right thing to do. Not everything in the Health and Social Care Act 2012 was approved by Opposition Members or many other people, but that change was the right thing to do. The cuts in authorities’ budgets—£200 million of in-year cuts—must be restored and I suggest that the ring fence is extended at least to the end of this Parliament. With local government having so many problems, I fear that breaking the ring fence for public health will mean that the money goes elsewhere and is not focused on these issues.

As I have said, only a minority of health inequality issues involve the Department of Health, but I want to highlight one that quite certainly does. The biggest cause of the hospitalisation of children between the ages of five and 14 is dental caries: 33,124 children went into hospital to be anaesthetised and have their teeth extracted in the past year. Incidentally, that is 11,000 more than for the second biggest cause of the hospitalisation of children, which is abdominal and pelvic pain. Believe it or not, it was the 12th highest cause of hospitalisation of tiny children below the age of four.

This is a health equality issue. Almost all the children who went into hospital were from deprived communities, including 700 from the city I represent. There is a safe and proven way dramatically to reduce tooth decay in children, and it also has a beneficial effect on adults. It involves ensuring the fluoridation of water up to the optimum level of 1 part per million. The cost of fluoridation is small. For every £1 spent there is a return to the taxpayer of £12 after five years and of £22 after 10 years. The evidence—from the west midlands and the north-east, and from countries across the world—has now existed for many years. A five-year-old child in Hull has 87.4% more tooth extractions than one living in fluoridated Walsall. The whole medical profession, the dental profession, the British Medical Association and the Department of Health have recognised that for many years.

In Hull, we intend to fluoridate our water as part of a concerted policy to tackle this element of health inequality. We need the Department of Health to show moral leadership by encouraging local authorities in deprived areas to pursue fluoridation, and supporting them when they do. The Health Secretary retains ultimate responsibility for public health, including ill-health prevention. This is one issue on which he can begin the process of reducing hospital admissions by encouraging preventive action and, in terms of health inequalities, giving poor kids prosperous kids’ teeth.

The edit just sent has not been saved. The following error was returned:
This content has already been edited and is awaiting review.

I completely agree with the right hon. Gentleman. Has he or anyone else solved the problem of how to protect water supply companies and businesses so that they do not find themselves facing unjustified claims or difficulties?

The edit just sent has not been saved. The following error was returned:
This content has already been edited and is awaiting review.

I had actually finished my speech, but I will answer the hon. Gentleman’s intervention as my conclusion. I have talked to Yorkshire Water, and my understanding is that putting the focus on local authorities changes the whole dynamic of how the various conspiracy theorists can attack on this issue.

The edit just sent has not been saved. The following error was returned:
This content has already been edited and is awaiting review.

It is a great pleasure to follow the very thoughtful speech of the right hon. Member for Kingston upon Hull West and Hessle (Alan Johnson).

Today’s subject, reducing health inequalities, is very far reaching. I will focus on obesity, as I chair the all-party parliamentary group on obesity, and also sit on the Health Committee and was involved in producing the report that my hon. Friend the Member for Totnes (Dr Wollaston) has alluded to.

I make no apology for talking about obesity again in the Chamber. Alongside terrorism and antimicrobial resistance, it poses a major threat to our nation. More than one in five children are overweight or obese before they start primary school; that figure rises to more than one in three as they start secondary school. Our children—our future generations—are at risk of developing serious health conditions such as type 2 diabetes, heart disease and cancer. Recent data have shown the continuing and widening inequality gap in the overweight, obese and excess weight categories for reception and year 6 children. Some 60% of the most deprived boys aged five to 11 are predicted to be overweight or obese by 2020, compared with a predicted 16% of boys in the most affluent group— 60% versus 16%. Overall, 36% of the most deprived children are predicted to be overweight or obese by 2020 compared with just 19% of the most affluent.

Those vast inequalities must be tackled, and, as the Health Committee inquiry into childhood obesity stated, we need to take “brave and bold” action. Every study around at the moment shows that higher obesity rates are linked to deprivation. Critically, the national child measurement programme showed that the gap between areas less affected and those where childhood obesity is more prevalent is growing. That cannot and should not be ignored. We need to see it as a wake-up call, highlighting the fact that many of our young people could face a future riddled with the complications of obesity—as I have said, those include diabetes, heart disease and cancer—as well as the immense strain we risk putting on our public services and the potential emotional impact on our population. Medics are reporting cases of type 2 diabetes in children. That is shocking and frightening, as until recently it was thought of as a disease only of the older population. It is a reminder, yet again, that action is needed to prevent a public health calamity.

I will focus now on the overall impact of obesity in adults. It is important we provide parents with every tool possible to make sure they can be great role models when it comes to what we eat and our lifestyles.

The edit just sent has not been saved. The following error was returned:
This content has already been edited and is awaiting review.

I am sure that my hon. Friend is aware that last week Tesco announced significant changes to the amount of sugar in its drinks. It did so off its own back. What are her views about how such pressure from the supermarkets could influence outcomes for our children?

The edit just sent has not been saved. The following error was returned:
This content has already been edited and is awaiting review.

My hon. Friend makes a good point. It is not just Tesco that has done that; so have Waitrose and Morrisons, to name just two—I am sure there are many more. It is really good that major retailers have taken on board the severity of the challenge faced both by us as a nation and globally. Parents need to be role models, as do retailers. Sometimes they are not quite the role models that they should be, but we need every bit of help we can get.

It is not just childhood obesity that is linked to social class and to different levels of deprivation; adult obesity is, as well. The highest prevalence of excess weight for both men and women is found among low socioeconomic groups. If current trends continue, almost half of women from the lowest income quintile are predicted to be obese in 2035.

Obesity is the single biggest preventable cause of cancer after smoking. The Government acknowledge the importance of early cancer diagnosis, and dedicated NHS staff at all levels are committed to delivering that, so surely every preventive measure that can be put in place, must be. As previously noted, as well as cancer, obesity leads to a greater risk of type 2 diabetes and heart disease. Those conditions are all life-changing and life-limiting.

I am sure people now understand that there is a link between obesity and diabetes, but, sadly, I fear that many think they can just take a pill to keep diabetes under control. Sadly, for far too many diabetes sufferers, that is not the case. The consequences are vast, with many diabetes patients needing lower limb amputation and suffering kidney disease, heart disease and sight loss—as I said, it is life-limiting and life-changing. Action needs to be taken now to turn around what I believe has become an obesity epidemic.

Everything I have talked about should prompt a reconsideration and review of the Department of Health’s childhood obesity plan. Although the Government were leading the world in producing the plan for action, when it was published, many, myself included, said that it was quite a let-down. I stand by that view. There simply was not enough detail in that 13-page document. It was aspirational, rather than a focused plan of action; it ignored the recommendations of Public Health England, which were endorsed by the Health Committee; and it did not set firm timescales for turning the tide on childhood obesity.

The plan we have is insufficient for the scale of the task we have to tackle. That does not mean starting all over again, however; it means that we need to do more. We need clear actions and timescales. I acknowledge that there is a fine balance between a nanny state, business co-operation, and parental and personal responsibility, but I am sure it is not impossible to find that common ground. Yes, it is the responsibility of parents to ensure their children eat healthily, are physically active and learn good habits that will last a lifetime, but time and again that has proven insufficient by itself. Parents need more help and the current childhood obesity plan cannot and will not give them what they need.

It would also be a mistake to think the answer lies in burdensome regulation of business, namely the food and drink sector. Demonising that sector is both unhelpful and unfair. As we have discussed, some producers, manufacturers and retailers have already taken great strides in reformulating products and encouraging healthier consumer behaviour. We must commend them and welcome those actions. Evidence suggests that the least affluent households in the UK have higher absolute exposure to junk food advertising than the most affluent households. Interventions such as reducing the promotion of junk food, or the soft drinks industry levy, are likely to have a positive impact on reducing health inequalities by delivering change across the population and consequently delivering disproportionate benefit to the most deprived communities.

Just as the current plan does not help parents, however, it likewise does nothing for business, which would be better served by clear goals for reformulation, advertising and labelling, and timeframes in which those must be achieved. Both publicly and privately, many businesses in the sector note that they would be better served by clearer, more far-reaching Government recommendations that at least gave them a measure of certainty for the future.

We may well be horrified by the national child measurement programme figures and other data we read on an almost daily basis now. Just this week, Cancer Research UK revealed that teenagers drink almost a bathtub full of sugary drinks on average a year—I hope that a visual representation will shock some teenagers into changing their habits rather than suffering the consequences.

The edit just sent has not been saved. The following error was returned:
This content has already been edited and is awaiting review.

The hon. Lady is making an excellent and thoughtful speech—she will be pleased to hear that there has been nothing in it that I have disagreed with so far. Was she therefore as disappointed as I was at the removal from the childhood obesity plan—we can only guess at why—of targets on halving childhood obesity, as well as measures on advertising and marketing that would have helped with the issues she has been discussing?

The edit just sent has not been saved. The following error was returned:
This content has already been edited and is awaiting review.

I thank the hon. Lady for that intervention. I will come on to that point when I make some requests of the Minister towards the end of my speech.

We know that childhood obesity levels will not drop tomorrow, but we need to see some signs in the next few years that they are declining. The foundations of an effective strategy are readily available in the form of the Public Health England recommendations and the Health Committee’s report.

In conclusion, when the Minister responds, I would like to hear a firm commitment to the soft drinks levy; clear goals for product reformulation and timeframes within which those should be achieved; action on junk food advertising during family viewing; and action on supermarket and point-of-sale promotions—for example, we do not want to go to buy a newspaper and be offered a large bar of chocolate. I would also like to hear what accountability will be put in place to ensure that schools provide the exercise outlined in the plan. Such measures would ensure that we had a strategy, rather than just a vision, and enable us to start tackling the obesity challenge in our society today.

The edit just sent has not been saved. The following error was returned:
This content has already been edited and is awaiting review.

I, too, thank the hon. Member for Totnes (Dr Wollaston), the Chair of the Health Committee, for bidding with colleagues for this crucial debate and the Backbench Business Committee for granting the time. There is probably no other person in this place who is better placed than her to talk about health inequalities, and her speech demonstrated that clearly. It was both challenging and thorough. It is a pleasure to follow the hon. Member for Erewash (Maggie Throup), and it was good to learn a bit more about obesity.

Many will say that health inequality stems from the overarching inequalities in education and opportunity across the country and even within communities, and that is true. My right hon. Friend the Member for Kingston upon Hull West and Hessle (Alan Johnson) outlined the historical context of that. However, I would say that health inequality starts even before birth—before a child is born into affluence or poverty; long before they have the opportunity to start at a good nursery or are left to make do with what is left; and years before they start making their own life choices.

Yes, health inequality begins in the womb and the child’s development can be very much restricted or enhanced by the diet of the mother, her tendency to drink alcohol or smoke in pregnancy, and dozens of other factors relating to antenatal care and access to general practitioners. Where people live has a major impact on all those things, but the effect can be mitigated by the actions of the NHS, local authorities and, of course, the Government. They can all, given the resources, make the kind of interventions that are needed to support people where that support is needed. The issue is one of resources, which are needed for everything from mounting campaigns to discourage smoking in pregnancy to providing the best hospital facilities in the areas of greatest need.

I will talk about my area, the borough of Stockton-on-Tees, and the north-east of England to illustrate the reality of health inequalities and the poverty that plays its own part in people’s life chances and life expectancy, and to show just why Government policy is putting the brakes on the progress we made in the years up to 2010. I will start with some facts. There is a life expectancy gap of 17 years between men in the most deprived ward in Stockton and a man in the least deprived ward, and the gap is over 12 years for women. That gap has increased by two years over a five year period, and unless we take immediate measures, I fear it will continue to grow.

Child development is an important contributor to health equity, as the successes and opportunities that children receive contribute to their quality of life later on. The English average for children achieving a good level of development at five years old is 60%, but in Stockton the figure is just 50%. A child who has a low quality of health due to parental lifestyle is more likely to be out of school more often due to illness, especially when it comes to dental health, with 72% of children in the most deprived areas having decayed, missing or filled teeth. My right hon. Friend the Member for Kingston upon Hull West and Hessle offered much more information on that problem and solutions to it.

In my constituency, the biggest causes of early death are cardiovascular disease, cancer and smoking-related diseases. The number of hospital stays due to alcohol-related harm is 808 worse than the average for England. That represents 1,500 stays per year. The rate of self-harm hospital stays is 225 worse than the average for England and the rate of smoking-related deaths is 320 worse.

Sadly, the positon in the north-east region is similar and there are some startling statistics, many of them related to alcohol. Some 57% of people living in the north-east, or about 1.2 million individuals aged 18 or over, have suffered at least once due to the drinking of others in the last 12 months. Some 62% of people know at least one heavy drinker. Males, younger age groups and those who drink the most were more likely to know a greater number of heavy drinkers. A third of north-easterners drink above the Government’s recommended limits on a daily or almost daily basis, and one in five binge drinks on a weekly basis. More than 60% of us worry about violence caused by drinking and 90% of us are concerned about people being drunk and rowdy in public. There is a strong relationship between alcohol and crime. Almost half of all crime is alcohol related and that is having a significant impact on individuals and communities.

While smoking rates in the north-east have declined over the past two decades, Fresh, a great charity, reports that 18.7% of adults still smoke and nearly 9,000 children in the region start smoking every year, according to Cancer Research.

The north-east has the highest rate of economic inactivity in England. Between July 2014 and June 2015, 25.3% of the working-age population in the region was economically inactive, with over a quarter of that inactivity due to ill health. The regional unemployment rate remains the highest in the UK at 7.9%, while life expectancy is lower than the English average. Men and women in the north-east typically live over a year less than the national average.

My constituency and much of the north-east reflect the picture across poorer parts of the country, and the evidence from charities and experts on these issues show them to be highly significant. A British Lung Foundation briefing on health inequalities found that people living in the poorest areas will die, on average, seven years earlier than those in the richest areas. There is a strong correlation, which is backed up by much evidence, that shows that a person’s affluence and opportunities affect their health. Cancer Research UK has carried out research that shows that inequality is linked to 15,000 extra cases of cancer in England and that children from the most deprived groups are twice as likely to be obese than the least deprived groups.

So there is quite a dire picture across the north-east region, but that is not for want of action by health groups, local authorities and charities. They have had some remarkable successes over the years, despite the poor hand dealt them, but they need the support of the Government to make even better progress. To reduce health inequalities, we need to provide more resources to support those who seek help; to invest in our health services to detect illnesses earlier; to ensure that healthcare has a greater role in schools; to stop those 9,000 children a year taking up smoking; and to ensure that the NHS has the means to look after and treat everybody who needs it.

Back to Stockton, how do we ensure that those who live there are not at a significant disadvantage from birth compared with those in more affluent areas? We must start from the beginning. By investing in early years education, we can make sure that all children have the best start in life and reach their key development milestones to the best of their ability. As I suggested earlier, we can start before they are even born.

The borough council has taken a number of measures to address the health inequality within the borough. The delivery of the health and wellbeing strategy is increasingly being targeted at those who most need support. For example, the Stockton seasonal health and wellbeing strategy co-ordinates a targeted approach to make sure that those who need the most support are getting it. Some 18,000 people have received winter warmth assessments to make sure their homes are prepared for the winter months, and Stockton Borough Council is working with Public Health England to implement a child dental health programme in schools, including even in nursery—isn’t that sad!—and for reception children. In our poorest wards, the council runs a community-led initiative focusing on three key outcomes for children up to three years old: cognitive development; speech and language development; and nutrition. These schemes are ensuring that children have more opportunities to break a cycle of health inequality in some areas of my constituency, and some areas in the wider country, and promoting a healthier and safer upbringing.

As I keep repeating, however, all these schemes need resources, but those are sadly diminishing as each year goes by. I could bleat on about the poor deal the north-east got from the coalition and is now getting from the Tory Government—the movement of health resources from the north to the south and the huge cuts to local authority spending, which have impacted on their ability to maintain the services they need in order to close the equality gap—but I will not. I will, however, remind the Government that while new hospital projects in Liberal Democrat and Tory constituencies planned by the last Labour Government went ahead in 2010, the one to serve my own and neighbouring constituencies was axed.

Our health professionals and trusts do a remarkable job in our area in the most difficult of circumstances, and I hope that one day soon they will have the 21st-century hospital and facilities they need to serve our community and help close that inequality gap. Perhaps the provision of that hospital should form part of the sustainability and transformation plan for our region. Instead we face the potential downgrading of our hospital and the potential loss of our accident and emergency department.

The challenge posed by health inequalities, not just in my area, is bigger than any individual parent, and bigger than any local authority or health trust. We must have a unified strategy to ensure that health inequality is a thing of the past and that my constituents, as well as those of many other Members, have the best start in life and a good quality of life. We need earlier intervention in schools, more support for those suffering from mental health problems, and greater action to break the cycle of health inequality in the poorest areas of the country.

I am well aware that we heard one of the gloomiest outlooks for our country from the Chancellor for decades when he delivered his autumn statement yesterday. He spoke of the uncertainty ahead, of rising debt and borrowing and falling growth and tax revenues. My great fear is that in the tough years ahead, partly as a result of the Government’s failure properly to fund public health, the NHS and social care, we will see health inequalities grow, not reduce, and that the huge gap in life expectancy will not be closed for many decades to come.

We should have a country not where the future opportunities and health of children are determined by their socioeconomic status or the availability of resources to tackle the issues of smoking, alcohol, drugs and inactivity, but where children yet to grow up or be born have the freedom to choose whichever path they want to take without negative health implications holding them back.

The edit just sent has not been saved. The following error was returned:
This content has already been edited and is awaiting review.

I follow previous speakers in this debate with a certain trepidation. I hope that I can live up to their mark. I congratulate the shadow spokesperson, the hon. Member for Washington and Sunderland West (Mrs Hodgson), with whom I have worked closely on issues around basketball. I should also draw the House’s attention to my entry in the Register of Members’ Financial Interests. I also congratulate my hon. Friend the Member for Totnes (Dr Wollaston) on securing this debate. As a fellow Devon MP, she might know something about the issues I want to talk about—it would be helpful to have a conversation with her afterwards.

In my constituency, there is an 11-year life expectancy difference between the north-east of my patch, where the professionals live, and the south-west, in Devonport, which is best known for its dockyard. Last week, I chaired a supper in Plymouth with health practitioners and academics on the subject of iron-deficiency anaemia in Devon. I will not pretend to be a medical expert—as hon. Members can probably tell, that is something that rather bypassed me—but it is a condition where the body has a low red blood cell count, resulting in less oxygen getting to organs and tissues. It can have serious consequences and often leads to more admissions to hospital or a deterioration in health.

The condition is a result of poverty—especially, but not exclusively, among the over-75s. I was horrified to learn that Plymouth is top of the national list of iron deficiency. The rates of iron-deficiency anaemia are four times the national average. In the Northern, Eastern and Western Devon area, which includes Plymouth, there were 1,530 in-patients with IDA in 2014, a 19% increase on 2013, following a steady rise over the previous few years. I understand that in 2014 this amounted to an avoidable cost to the local health economy of just over £1 million.

I want to focus on NHS England’s desire to close three GP surgeries in my constituency by next March. I fear that this action will serve to put greater pressure on the principal acute hospital at Derriford, in the constituency of my hon. and gallant Friend the Member for Plymouth, Moor View (Johnny Mercer). I am told that the reason why NHS England is considering the closures is the size of the GP practices. I understand there is a Nuffield report that says that that should not be the only thing taken into account. The Cumberland GP practice has 1,800 patients, Hyde Park has 2,800 and St Barnabas 1,700. They are considered by NHS England to be unsustainable and too small, despite the fact that they are growing practices. I have mentioned some of these issues before, but I have no problem repeating them. I was told that closing the practices is not down to saving money, but is about delivering better value for money. However, before I speak about those issues, let me put my constituency in some context.

Plymouth, Sutton and Devonport runs from the A38 down to sea, and from the River Plym to the River Tamar. It is home to one of the largest universities in the country, with more than 27,000 students, thousands of whom live in the city centre. It is a naval and Royal Marines Commando garrison city, as the Minister of State, my hon. Friend the Member for Ludlow (Mr Dunne), for whom I was previously a Parliamentary Secretary, knows only too well. Before the November recess, the Ministry of Defence sadly confirmed that it would be releasing Stonehouse Royal Marines barracks and announced that the Citadel, which is where 29 Commando is based, would be released back to the Crown Estate. Fortunately for Plymouth, the MOD also announced that the Royal Marines and their families would be transferred from Chivenor, in the north of Devon; Arbroath, up in Scotland; and Taunton, just up the M5. While the city’s population is growing, this announcement will almost certainly put even greater pressure on our schools, our hospitals at Derriford and Mount Gould, and our GP practices.

Although Plymouth has a global reputation for marine science and engineering research, it is a low-wage, low-skills economy. It is an inner city—something pretty unique for a Conservative to represent, if I might say so. Indeed, I do not have a single piece of countryside in my constituency, unless we include the Ponderosa pony sanctuary, which is a rather muddy field. In the run-up to the 2010 general election, when I won the seat on the third attempt, the Conservative party pledged to do something about healthcare in deprived inner cities. We have started to make good our word, and in 2014 my hon. Friend the Member for Central Suffolk and North Ipswich (Dr Poulter)—one of the Minister’s predecessors —came to Devonport to open the Cumberland GP practice, which is now very much under threat. Other facilities on the Cumberland campus include a minor injuries unit, the Devonport health centre and a pharmacy.

The Cumberland GP practice was set up by Plymouth Community Healthcare—now Livewell Southwest—and the Peninsula medical school. There was, and is, a desperate need to provide a tailor-made alternative service to the existing GP practice—then the Marlborough Street practice, now the Devonport health centre—for this deprived Devonport community and a need to look after drug users and the city’s homeless in hostels such as the neighbouring Salvation Army hostel. The practice also offers practical placements to students at the Plymouth medical school. Until earlier this year, it was funded by Livewell Southwest, a social enterprise, which found it too expensive to maintain.

Despite Devonport’s real deprivation, NHS England did not want to get involved in providing a contract to the Cumberland GP practice, which has consequently been operating without a formal contract and is managed by Access Health Care. I understand that in the past the neighbouring Devonport health practice has not been interested in offering facilities to homeless people and drug users—it may change its mind, though. Indeed, I understand that some of the Cumberland practice’s patients were not keen to transfer back to the Devonport centre, which is where they came from in the first place.

NHS England’s reason for putting the Cumberland GP practice under threat is because it considers it to be too small and to be operating in unsuitable, cramped premises. Unless we are careful, we could put more pressure on Derriford’s acute emergency unit, which is already under enormous pressure.

I became aware of NHS England’s proposals for these three GP practices in August, during the summer recess, when NHS England no doubt expected me and other MPs to be away on parliamentary trips or taking a holiday—hard luck; I was there! I immediately put together a series of meetings with the city councillor director of public health, the leader of the council, the cabinet member for adult social care, people from NHS England, the dean of the medical school and Dr Richard Ayres, who runs the Cumberland GP practice. At that meeting, I suggested that the Cumberland GP practice should share the Devonport health centre’s brand-new building, which has space and operates as a federation, sharing the receptionists and backroom staff. This was supported by everybody present. Indeed, the city council’s health and wellbeing board also supported it, following an inquiry that recommended measures to allow the Cumberland GP practice to continue.

However, I understand that Devonport health care might not be willing to do that, so it appears that the Devonport community might be deprived of a second GP practice and patients will have no choice over which doctor they go to. The Northern, Eastern and Western Devon CCG is looking at ways to try to keep the Cumberland GP practice open, but it needs space in the short term while it considers alternative locations. I have also received representations from patients at both the Hyde Park and St Barnabas surgeries.

At Hyde Park, although Dr Stephen Warren is keen to continue as a GP, following a heart attack, he has transferred the ownership of his practice to Access Health Care because he no longer wishes to deal with the backroom tasks of administration, which is part of running a practice. He argues that his and his partner’s growing 2,800-patient practice—the Cumberland is growing as well—has attracted outstanding reviews, and that he would not be able to inform his patients where he was going if he relocated to another practice. He also thinks that some patients like to have a relationship with an individual doctor whom they can see speedily rather than having to wait weeks. It is rather like having one’s own personal bank manager, which I feel is quite important.

The St Barnabas surgery, which is also run by Access Health Care, was set up in a new development next to a residential care home for the elderly where patients do not have to walk very far to get to it. In all three cases, NHS England, for supposedly technical reasons, gave patients only 24 hours’ notice of its initial engagement. I must say, frankly, that I found the public consultation process utterly appalling. I wrote to NHS England asking it to give more time to engage with local communities, and I am grateful that it bothered to listen.

Recently, at my weekly constituency surgery, I was asked to write to NHS England to ask whether it had engaged with other GP surgeries and with Derriford hospital, and whether it had consulted them, because some GPs will have to accommodate more patients. That is a very big issue.

There are wider issues in all of this, too. At the moment, the commissioners in Northern, Eastern and Western Devon spend a higher amount of money in eastern Devon than in the more deprived western locality. The Government’s success regime is keen to correct that, so that resources are focused on deprived communities such as Devonport.

The edit just sent has not been saved. The following error was returned:
This content has already been edited and is awaiting review.

I wish to make an observation. Given the detail that my hon. Friend has gone into and how he seems to be representing his community in these deprived areas, I wish to observe how very fortunate they are to have this Conservative MP in that inner-city area.

The edit just sent has not been saved. The following error was returned:
This content has already been edited and is awaiting review.

It is generous of my hon. Friend to say that, and I shall try to intervene on similar lines later! [Interruption.] I also observe that there have been no mentions of hedgehogs in this debate.

Finally, as the Minister may know, I am the Government’s pharmacy champion, and the Government are reviewing the role of pharmacy to take pressure off our GPs and major acute hospitals such as the Derriford. Much has been made of the 6% cut, but there has been very little publicity of the £19 million that will be made available through the Government’s pharmacy access fund. My hon. Friend might like to use her winding-up speech to give us a little more information about all this, and to explain how the Department of Health will provide the resources for pharmacies to take pressure off GPs by delivering flu jabs, opticians, mental health services, anti-smoking measures and a nationwide minor ailment facility. If she cannot do that now, perhaps she would like to write to me about it.

Plymouth’s health service is under real pressure. Like the rest of the country, the town does not have enough GPs. Parts of my constituency are very deprived and we need to do something about the 11-year life expectancy difference. The Government must ensure that resources follow health needs. We also need to make much more use of pharmacies. As my hon. Friend the Minister knows, I am the Government’s pharmacy champion, so may I ask how we will ensure that pharmacies have funding, and how they will be able to operate?

The edit just sent has not been saved. The following error was returned:
This content has already been edited and is awaiting review.

Thank you, Mr Deputy Speaker, for calling me to speak in this important and, in my opinion, overdue debate. I thank the Chair of the Health Committee, the hon. Member for Totnes (Dr Wollaston), for initiating it, and I thank the Backbench Business Committee for allowing time for it.

I want to focus on an area of health inequality that receives disproportionately less funding than most others and, sadly, far less attention from Ministers than it is due. I am, of course, talking about dental and oral health inequality. Most people, when asked to describe what health inequality looks like in this country, would cite difficulties in seeing a GP, long waiting lists for treatment for common ailments, and the rationing of licensed drugs for those suffering from treatable diseases. I could, of course, go on. Most, however, would not immediately cite dental and oral health, although inequality in that area is just as widespread throughout the country as the many other important inequalities that Members have rightly highlighted today.

Let me underline my point by sharing with the House some unsettling figures that have caused me, as a Bradford Member, more than a few sleepless nights. Official figures reveal that five-year-old children in Bradford are four and a half times more likely to suffer from tooth decay than their peers in the Health Secretary’s constituency of South West Surrey. The number of children admitted to hospital for tooth extractions—they usually require a general anaesthetic—has risen by a quarter over the past four years. Shockingly, during the past year 667 children in Bradford alone have spent time in hospital for that entirely avoidable reason.

The edit just sent has not been saved. The following error was returned:
This content has already been edited and is awaiting review.

As someone who was born in Bradford, I can proudly say that, even at my age, I have only one filling. As with obesity, dental problems are often due to a lack of parental responsibility as well as environmental factors.

The edit just sent has not been saved. The following error was returned:
This content has already been edited and is awaiting review.

That is an interesting point. I shall deal with some of those issues later in my speech.

According to the latest figures, 32% of children in Bradford—nearly a third—have not seen a dentist for more than two years. Ideally, as Members will know, children should be given a check-up every six months.

Dental and oral health has been and continues to be the Cinderella of health service provision. It is seen as being “nice to have”—to be tackled once the good ship NHS has returned to calmer waters—and due for its much-needed extra funding only when the financial black holes elsewhere in the NHS have been plugged. Such inequality in dental and oral health is plain wrong. It is an unspoken injustice in today’s society, and the task of tackling it cannot and should not be kicked down the road like the proverbial can year after year.

Tooth decay is an almost entirely preventable disease. It is a scandal, without exaggeration, that tooth decay is the No. 1 reason for hospital admissions of children between the ages of five and nine. It is a scandal not only because it causes our children needless pain and suffering, but because, in this time of austerity, it wastes countless millions in NHS resources. However, its impact goes much deeper than that.

In an increasingly globalised and competitive world in which our children are expected to succeed at school, improve their skills and excel in internationally benchmarked exams, they all need to be healthy and energised to face the school day. Too often, however, pain arising from poor oral and dental health hinders their school readiness, impairs their nutrition and growth, and cripples their ability to thrive, develop and socialise with each other. A recent survey sadly confirmed that more than a quarter of our young people feel too embarrassed to smile or laugh due to the condition of their teeth. For our teenagers, the injustice is no less when they need to succeed and make their way in a competitive job market.

The edit just sent has not been saved. The following error was returned:
This content has already been edited and is awaiting review.

In my constituency, I can tell the extent of someone’s poverty by the state of their teeth, so not only is there the issue of decay, but this is about not having the money to be able to get the necessary treatment—perhaps cosmetic treatment—which can then lead to embarrassment and a loss of confidence.

The edit just sent has not been saved. The following error was returned:
This content has already been edited and is awaiting review.

I thank my hon. Friend for making that valid and important point.

Disproportionate levels of poor oral and dental health, predominantly in deprived, low-income areas such as those in Bradford, hamper these young people from forging their careers. Survey after survey confirms that young people who suffer from poor dental and oral health face poorer job prospects. Dental and oral health plays, rightly or wrongly, an important part in selling ourselves in today’s competitive job market.

I have set out the depressing scale of the challenge, but what can we do—or, perhaps more accurately, what can and should this Government be doing—to tackle this scandalous health inequality? As I highlighted to the former Prime Minister Mr Cameron, when I challenged him about this inequality in my constituency and city, there are some simple steps that can be taken. The first of them is due to be implemented in the foreseeable future: a tax on sugary drinks. Although the Government’s final proposal was very much weaker than it should have been, it was nevertheless very much a welcome step in the right direction.

The Royal College of Surgeons faculty of dental surgery, a professional body that sees dental inequalities first hand in its day-to-day work, suggests a number of low-cost, easily deliverable measures that could readily be adopted by Government: tightening restrictions on advertising high-sugar products on television, for example by restricting advertisements before the 9 pm watershed; limiting price promotions in supermarkets for high-sugar foods and drinks, and excluding these products from point-of-sale locations such as checkouts and counters; and, most sensibly, limiting the availability of high-sugar foods and drinks in our school system.

Perhaps the most important measure that the Government could implement, as highlighted by the British Dental Association, would be to expedite changes to the current dental contract. Critical changes are long overdue, the first of which would be to incentivise preventive work through the contract. The second, and most important, would be to incentivise the dental profession to establish new practices in deprived areas. Such areas desperately need practices as people there typically face the least availability.

In my constituency, despite need being so high, there is a shameful shortfall of NHS dentist appointments. Very few NHS dentists have open lists, meaning that most people in search of dental treatment simply give up, and those who are determined end up finding a dentist outside the city boundaries. Surely that is not right. I understand that the Government hope to begin rolling out a reformed dental contract from 2018-19 onwards, but that simply is not soon enough.

I finish by asking a simple question: is it just and equitable that five-year-old children in Bradford, my home city, are four and a half times more likely to suffer from tooth decay than their peers in the South West Surrey constituency of the Health Secretary? I hope that the House agrees that the answer is no.

The edit just sent has not been saved. The following error was returned:
This content has already been edited and is awaiting review.

I am very pleased to follow the hon. Member for Bradford South (Judith Cummins), who gave such a shocking account of oral and dental health. I am also delighted to follow my hon. Friend the Member for Totnes (Dr Wollaston). I commend her for raising this important issue and for so ably highlighting the impacts and causes of health inequality.

I want to focus on an area my hon. Friend did not mention, and to bring it to the Minister’s attention: natural and green solutions to help to reduce and prevent the disparity and inequality in health outcomes. I am not suggesting that the things I am going to mention are the only solutions, but I really believe that our natural environment has an important and often underestimated role to play in our health and wellbeing. Health inequality can cost up to £70 billion a year, with those below the wealthiest levels in society suffering the greatest degrees of inequality. Many of my colleagues have expanded on that point today. I have a particularly deprived area in my constituency called Halcon, which is among the 4% most deprived parts of the country. Many of the factors being described today apply to that part of Taunton Deane.

Interestingly, people living in deprived areas are 10 times less likely to live in the greenest areas. That seems more than a coincidence. There must be a link. In fact, I can tell the Minister that research shows that disadvantaged people who have greater access to green spaces are likely to have better health outcomes. A good-quality natural and built environment can have a significant positive impact on mental and physical health. Not only that, but some of the solutions that I am going to mention can be cost-effective. I know that the idea of cost savings will always make a Minister’s eyes light up. Many people are beginning to realise the important link between health and wellbeing and the natural environment, and I am heartened that many service providers are already thinking about that and putting people in place to deal with it. For example, the Somerset Wildlife Trust, of which I am very proud to be a vice-president, has appointed Jolyon Chesworth as its first health and wellbeing manager. That is heartening, and I shall watch with interest to see how that role develops and what the trust will do to highlight this issue.

The natural world can have a really positive impact on mental health. I am a firm believer in the therapeutic power of a brisk walk in the beautiful Somerset countryside. Maybe we can stretch that to include Devon.

The edit just sent has not been saved. The following error was returned:
This content has already been edited and is awaiting review.

Does my hon. Friend agree that one of the great problems is that mental health care has been a Cinderella service in the NHS for far too long? Does she also agree that the Government are trying to do something about that?

The edit just sent has not been saved. The following error was returned:
This content has already been edited and is awaiting review.

My hon. Friend is right; it has been a Cinderella service.

The solutions that I am outlining are free. I am giving the House ideas for free therapy, because nature is free. It is a beautiful thing, and it really does have power. What could be more relaxing than a walk up to the Wellington monument on the Blackdown hills in my constituency? Hundreds of thousands of people go up there, including lots of people with disabilities, because it is easy to get to and it is all flat. Those walks to the monument are really beneficial. I know that it is not quite relevant to the debate, Mr Deputy Speaker, but the Government raised my spirits yesterday by announcing that they were giving £1 million to the Wellington monument’s restoration project from the LIBOR fund. That will have loads of spin-offs for the public, and health and wellbeing will be part of that. We are going to build a big community project to encourage more people to go up there.

When I was looking for somewhere to live in London—obviously, I have to stay up here during the week—one of my criteria for the flat was that I had to be able to see a tree from my window, and I can. I could not live without one.

The edit just sent has not been saved. The following error was returned:
This content has already been edited and is awaiting review.

I congratulate my hon. Friend on the points that she is making. There are good data to back up what she is saying. Public Health England estimates that an inactive person is likely to spend 37% more time in hospital than someone who is active, and that inactive people are 5.5% more likely to visit their doctor. There is a good evidence base for what she is saying.

The edit just sent has not been saved. The following error was returned:
This content has already been edited and is awaiting review.

That is absolutely true, and I shall give the House a few more statistics as I go on. I am not making this up. This is not wishy-washy; it is actually coming into our psyche.

The edit just sent has not been saved. The following error was returned:
This content has already been edited and is awaiting review.

May I encourage my hon. Friend, when she is in London, to take a boat from Chelsea Harbour down to Greenwich? She will see the magnificent layout of trees that occurs beautifully in the west, although there seem to be fewer of them in east London.

The edit just sent has not been saved. The following error was returned:
This content has already been edited and is awaiting review.

rose—

The edit just sent has not been saved. The following error was returned:
This content has already been edited and is awaiting review.

Order. I do not want us to get into a forestry debate. I admire this love-in for the south-west, but I think we need to get back to health.

The edit just sent has not been saved. The following error was returned:
This content has already been edited and is awaiting review.

I did actually go out on a boat up the Thames this morning with Greenpeace to look at the issue of microplastics in water, and we also saw some trees. Trees are important and serve a good purpose in taking in air pollution, which has an effect on health; we have a lot of asthma in our cities. If we plant more trees, we will help to combat all that.

It has been demonstrated that mental health can be aided through contact with nature. As a keen gardener, I can vouch that getting one’s hands in the soil, watching things grow, planting seeds and watching the seasons change definitely does lift the spirits and is a pick-me-up.

The edit just sent has not been saved. The following error was returned:
This content has already been edited and is awaiting review.

My hon. Friend makes a good point that brisk walks are not the only thing that can help health. Last Friday, I was helping some young children at Chaucer Junior School to plant bulbs in the school’s grounds. We were getting exercise out in the fresh air in an area that is quite built up and urban, which must be a good thing for their future health.

The edit just sent has not been saved. The following error was returned:
This content has already been edited and is awaiting review.

My hon. Friend is absolutely right. Many schools run gardening groups. There is so much to take from gardening, and it can also help the unemployed and other groups. Gardening is physical activity, but watching things grow out of the soil is so beneficial. In fact, Royal Horticultural Society research shows that 90% of UK adults say that just looking at a garden makes them feel better. Doing something in a garden is better, but one can also just look. There were data recently about watching birds on a bird table or hedgehogs. If someone has the chance to watch a hedgehog, that could make them incredibly happy because they are so rare now. I got terribly excited when I recently saw one eating my cat’s food.

The edit just sent has not been saved. The following error was returned:
This content has already been edited and is awaiting review.

I do not want to rain on the hon. Lady’s garden as such, but does she agree that there can be a negative impact on someone’s mental health if their surroundings are not good? Some 60% of people in Glasgow live within 500 metres of vacant or derelict land, which can negatively affect their mental health.

The edit just sent has not been saved. The following error was returned:
This content has already been edited and is awaiting review.

That is such a good point. We need to be doing something with derelict land as communities. The Woodland Trust has some great data saying that, if someone lives 500 metres from a wood, their health will be better because not only can they go into it, but they can look at it and enjoy it. The mental health charity Mind produced a report called “Feel better outside, feel better inside” that advocates the benefits of ecotherapy. Ecotherapy improves mental and physical wellbeing and boosts people’s skills and confidence to get back into work by taking part in gardening, farming, growing food, exercise and conservation work. Some 69% of people who took part in such projects definitely saw a significant increase in their mental wellbeing and 62% thought that their overall health was improved. The projects helped 254 people find full-time work, which saves the nation money because they no longer need support.

In my constituency, a job agency called Prospects has a contract to get the long-term unemployed back to work. It does gardening with groups of people, but it also does forest walks. I have been out with them in the Neroche forest, which contains a lot of ancient woodland. It definitely helps people not only to engage in nature, but by giving them confidence because they are talking to each other and getting out in a different atmosphere—not an office. Many of those people then have the confidence to apply for jobs and get back into work. There is a clear case for having the prescription of access to green space in the armoury of traditional medical treatments to deal with a range of mental health issues.

We also have physical health to consider. The great outdoors is a vastly underutilised tool, in the wider sense. Many of my colleagues have been talking about obesity and the outdoors can play an important part in our fight against it. Obesity, particularly childhood obesity, currently costs the Government £16 billion, and those living in deprived areas are twice as likely to be obese.

With that in mind, I advocate that consideration be given to green prescriptions. The Local Government Association has recently called on the UK to implement a similar model to that used in New Zealand, where eight out of 10 GPs have been issuing green prescriptions to patients, with 72% of them noticing a change in their health. The LGA is encouraging GPs to write down moderate physical activity goals for their patients, including things such as walks in the park and all-family classes that they can go to. A number of GPs are already using these schemes on Dartmoor and Exmoor, and in one pilot people are being encouraged to visit the national parks, which are beautiful, on their doorstep and free to enter. I am recommending all these things. Councillor Izzi Seccombe, chairman of the LGA’s health and wellbeing board, said that writing such a formal prescription encourages many more people to get out and do the activity. If the doctor says that people must take a pill, they take it, so if the doctor says that they must go out for a walk in the wood, people might do it.

A great many initiatives are already taking place, such as NHS Forest, which aims to improve the health, wellbeing and recovery times of patients and staff by increasing access to NHS gardens—the locations on the doorsteps of the hospitals. As part of the Health and Social Care Act 2012, a statutory duty was placed on local authorities to create health and wellbeing boards. However, the Health Committee has reported that those were not working very successfully and have few powers. Perhaps the Minister might examine that, as they could start to make a big difference in moving this agenda forward.

There was a proposal in 2015 for a nature and wellbeing Act, which was much discussed and debated. That sought to put nature at the heart of all the decisions we make about health, education, the economy, flood resilience and so on. Perhaps, Minister, we could re-examine some of the ideas in there, because some of them are very good. We know that there are links between access to green space and health. It seems a no-brainer to me—if we can improve access to green space and look into the idea of beginning to prescribe these green treatments, we could really make a difference to health and health inequalities.

That would be much easier if we had all the data and we could prove these benefits with those data. Help is at hand, because the Wildlife Trust has commissioned a piece of work; it has commissioned the school of biological sciences at the University of Essex to gather just such data. Once we have some solid facts, we can really move forward. I would like to think that the Minister will consider some of these ideas. When the Cabinet Minister for tackling health inequality is put in place, as was recommended by my hon. Friend the Member for Totnes—or perhaps the Prime Minister could lead on this, as recommended by the right hon. Member for Kingston upon Hull West and Hessle (Alan Johnson)—we might be able to add my green points to the agenda and really move forward to a healthier society.

The edit just sent has not been saved. The following error was returned:
This content has already been edited and is awaiting review.

It is a pleasure to follow the hon. Member for Taunton Deane (Rebecca Pow), who makes some interesting points. I also thought the intervention from my neighbour, my hon. Friend the Member for Glasgow Central (Alison Thewliss), about the landscape in Glasgow was particularly pertinent.

Let me begin by commending the hon. Member for Totnes (Dr Wollaston), whose campaigning efforts in health matters, coupled with her ability to challenge her own Government, are second to none. I thank her for securing this debate and the Backbench Business Committee for allowing the time for it to take place in the House today. It is clear from this debate that we are united as a House in wanting to eradicate health inequality, but the issue is how we work together to achieve that.

In her opening speech the hon. Lady referred to the Prime Minister using her first speech to proclaim that her Government would fight the “burning injustice” that plagues our society. I believe it is fair to say that most burning injustices lead back to health inequalities. Inequalities in health are underpinned by greater societal inequalities—the conditions in which we are conceived and born, grow up, live, work and grow old have an immense impact on our lives. Essentially, where there are social and economic inequalities there are health inequalities, and although they are most definitely unjust, they are certainly not unavoidable. Many people—our constituents—will die prematurely and needlessly each and every year as a result of these gross inequalities. This, wherever it occurs, is a human and moral tragedy that shames us all.

During the debate today, right hon. and hon. Members from across these islands will rightly speak about their constituent nations, regions, local constituencies and their particular competences, and England will be a key focus. I would like to complement this debate by talking specifically about Scotland, Glasgow and my constituency, Glasgow East. Despite vast progress in life expectancy in Scotland over the past 150 years, our life expectancy remains lower, and our average mortality remains higher, than our neighbours across the UK and throughout Europe.

The poor health status of Scotland and our largest city, Glasgow, is well documented and is largely explained by the experiences of deindustrialisation, deprivation and poverty. However, there are now greater levels of mortality that cannot be explained by deprivation, known as “excess mortality”. For example, premature mortality rates are 20% higher in Scotland than in England and Wales, even after deprivation is accounted for, and the premature mortality rate in Glasgow is 30% higher than in equally deprived areas, such as Liverpool and Manchester. The former has been dubbed the “Scottish effect”, the latter the “Glasgow effect”. Both account for approximately 5,000 extra, unexplained deaths per year in Scotland—that is, 5,000 people dying prematurely, dying needlessly, over and above normal inequalities in health.

Traditionally, the cause of this has not been entirely understood. Research suggests that it is a combination of a change in political power, increasing income inequalities, disempowerment and deindustrialisation, the last of which has impacted on people in many ways, such as through unhealthy behaviours, psychosocial stress and, of course, poverty. In May this year, the Glasgow Centre for Population Health, NHS Scotland, the University of the West of Scotland and University College London produced a report entitled “History, politics and vulnerability: explaining excess mortality in Scotland and Glasgow” which confirmed this.

The report, which was signed by over 30 academics and health professionals, found that Glasgow’s population was more vulnerable to factors that impacted on health across the UK, such as poverty, deprivation, deindustrialisation and economic decisions taken by the UK Government that have led to the population having poorer health outcomes. Such vulnerabilities arose from notoriously high levels of deprivation over a sustained period; urban planning decisions in the post-war period, such as the creation of monolithic, poor quality, peripheral housing estates; the regional economic policies of the UK Government and its Scottish Office; and local government responses to UK Government policies in the 1980s.

Again, where there are socioeconomic inequalities, there are health inequalities. These inequalities are not a mistake and they are not an accident, they are not inevitable and they are not irreversible. Income inequalities were relatively narrow in the UK until the late 1970s, and health inequalities declined dramatically. However, income and wealth inequalities soared again during the 1980s and 1990s, and so have health inequalities. Again, this did not happen by accident, nor did it happen in countries across the world. It happened in countries which, like the UK, made conscious decisions to roll back the state to the minimum level possible; to slash public expenditure like it was going out of fashion; to reconstruct the tax and welfare system to be less redistributive; and to champion the wants of business and the financial sector at the expense of the needs of workers and their trade unions. This was an ideologically driven Conservative Government hell-bent on pursuing a neoliberal agenda at any cost, come what may.

To break somewhat from the conciliatory tone, there were worrying signs that that approach was being mirrored by the previous Government. However, we have a new Prime Minister, and she has offered encouraging words about her Government’s ambition to fight burning injustice, but what she does matters more than what she says. Hopefully, today’s debate is a starting point.

The interventions the Government could make, which are more likely to reduce inequalities in health, are those that utilise taxation, legislation, regulation and changes in the broader distribution of income and power in society. As Michael Marmot, chair of the Marmot review, said in 2010:

“Simply restoring economic growth, trying to return to the status quo, while cutting public spending, should not be an option. Economic growth without reducing relative inequality will not reduce health inequalities.”

The Government must acknowledge that health inequalities cannot be solved with health solutions alone; they are rooted in poverty and income inequality, as well as across all areas of Government policy. Solutions from the Department of Health or the NHS will not suffice, as ably outlined by the right hon. Member for Kingston upon Hull West and Hessle (Alan Johnson). Therefore, the Government should commit to a joined-up, evidence-based approach of cross-departmental working, with a Minister from the Cabinet Office given specific responsibility for embedding health as a priority in all Government policy.

Inequalities in health are a matter of life and death, health and sickness, wellbeing and misery. They represent misery on the greatest scale imaginable. If the Government are looking to fight injustice, this is it. The only question is: are they up to the job, and are they willing to do it?

The edit just sent has not been saved. The following error was returned:
This content has already been edited and is awaiting review.

On the doorstep of No. 10, our Prime Minister, taking up her leadership mantle, gave an inspirational social justice speech, aimed at ensuring that we reduce health inequalities, including by addressing the stark realities of the mental health challenges that so many families in our communities live with daily. I want to speak about that, about the importance of healthy early relationships in life—even beginning before birth—and about the mental health challenges that can be involved. I would like to conclude with a reference to the implications of alcohol harm, wearing my hat as the chair of the all-party parliamentary group on alcohol harm.

Building healthy relationships—beginning before birth—and establishing them in our earliest years as building blocks in our family and community life are absolutely key for the prevention and reduction of mental health problems in childhood and throughout later life. That starts in the womb.

Let me commence by setting out some key facts from the early lives of our children here in the UK. Depression and anxiety affect from 10 to 15 of every 100 pregnant women. Over a third of domestic violence begins in pregnancy. One million children in the UK suffer from problems such as attention deficit hyperactivity disorder, conduct disorder, emotional problems and vulnerability to chronic illness, which are increased by antenatal depression, anxiety and stress. The UK has the world’s worst record for breastfeeding. Some 50% of three-year-olds experience family breakdown. Some 15,700 under-twos live in families classed as homeless.

By addressing some of those social determinants of health inequality, beginning even before birth, we could help exponentially, in terms of not just the physical but the mental health of so many of our young people, and that help would last their whole life long. We need to support our youngest, so that we can increase their life chances and reduce the health inequalities that get in the way of their achieving their full potential.

Points on the compass of scientific advancement are increasingly showing us the direction of travel in terms of the social determinants of health, and they significantly point towards the experiences of bump, birth and beyond. The top policy recommendation in Marmot’s “Fair Society, Healthy Lives” report, which was referred to by the hon. Member for Glasgow East (Natalie McGarry), and which was published as long ago as February 2010, was to give every child the best start in life. The “1001 Critical Days” manifesto, which is the UK’s only children’s manifesto with the support of eight political parties, was launched three years ago in response to that report.

A child’s development is mainly influenced initially by their primary care giver—usually their mother but often their father—and by others who are engaged with helping with their parenting. Parenting begins before birth. We have known for a long time that how we turn out depends on our genes and on our environment. Scientists now realise that the influence of the environment begins in the womb, and how the mother feels during her pregnancy can change that environment and have a lasting effect on the development of the child. So we all need to support and look after pregnant women, for their sake and that of future generations.

A stable and secure home learning environment is critical in the early months. Children, right from their infancy, need to be protected, nourished, and stimulated to think and explore and to communicate and interact with their parents and others. Babies are primed to be in relationships, and their earliest relationships really matter for the “ABC, 123” building blocks that lead to school-readiness. A young child’s earliest relationships develop their social brain, which will influence their later life. Eighty per cent. of our brain significantly develops in the earliest years and through our earliest relationships. I am focusing on that because it shows that healthy relationships really matter for our health and well being throughout life.

The edit just sent has not been saved. The following error was returned:
This content has already been edited and is awaiting review.

I know we are trying to make this a non-partisan debate, but does the hon. Lady recognise that all the things she is talking about require resources? Some of our most needy communities have seen a loss of those resources in recent times, and we need to do something to redress that.

The edit just sent has not been saved. The following error was returned:
This content has already been edited and is awaiting review.

I thank the hon. Gentleman for that intervention.

We need to focus on the fact that learning about and enjoying healthy relationships is a key determinant of future health, both physical and mental. Between 1.3 million and 2.5 million years of lives are lost as a result of health inequality in England. Many children never reach their potential throughout their life partly because of a lack of healthy relationships in their early years. Relationship breakdown is a significant driver of poverty and health inequality. A comprehensive cross-departmental strategy to combat health inequality must include measures to strengthen healthy relationships and combat relationship breakdown, which is at epidemic levels in our country.

I am chair of a mental health charity for children in my constituency called Visyon, which is overwhelmed by requests on behalf of children as young as four. When I asked its CEO how many of the problems of the children it helps are the result of poor early relationships in the home, he looked at me and said, “Virtually all of them.” This is an absolutely critical factor in a child’s early development and healthy life, particularly in relation to mental health. Interestingly, a wide-ranging survey by the Marriage Foundation published in May 2016, involving thousands of young people, found a noticeable difference between the self-esteem levels of children who were brought up in stable households and those who were not. Self-esteem acts as a predictor of a range of real-world consequences in later life.

When relationships break down, as they do in all socioeconomic groups, it disproportionately affects children in low-income families because they are less resilient in combating the impact. Half of all children in the 20% of communities that are least advantaged now no longer live in a home where they have healthy relationships—where, for example, both parents are still with them by the time they start school. I am not saying that a child cannot have a healthy relationship with one parent or another, but it is important that we grasp this nettle and appreciate that healthy relationships with a range of people—including, ideally, a mother and a father—are good predictors of early health. We should support that, and the Government and Health Ministers should be brave enough to tackle the issue. For too long, Ministers have shied away from looking at healthy relationships, yet we are happy to help and educate young people about how to build healthy bodies for physical health in life.

Relationship breakdown is a root cause of poverty. When relationship breakdown happens, households often suffer dramatic income reductions. There is also an impact with regard to infant mortality rates, hospital admissions and mothers in poor health.

I agree that we need more funding to strengthen relationships, to provide the early support that is needed in many different ways. We need to consider extending children’s centres so that they can become family hubs that provide support for the whole family. The recent report of the all-party parliamentary group on children’s centres, of which I am the chair, made that recommendation. We need to look at the availability of couple relationship advice, not just parenting advice. Sex and relationship education lessons in schools need a much stronger focus on relationship education. We need to provide a family services transformation fund, so that local authorities can share best practice. We need to do all of that to ensure that we give children the best start in life, and in particular to tackle the serious challenge of the mental health problems experienced by so many schoolchildren. So many headteachers say that it is a major issue with which they have to grapple.

In the final part of my speech, I want to refer to the different but not entirely linked issue of alcohol harm. I say that it is not entirely linked because people who experience or fall into addiction are often looking for a source of comfort in life that is missing from their relationships. I am not saying that it is not right to enjoy drinking, but it needs to be healthy drinking. Alcohol harm is a major issue in our society and I do not believe that the Government are doing enough to address it.

The Government must do more to tackle health inequality. For example, in January the chief medical officer published her recommendation that it is wisest for women not to drink during pregnancy. Pregnant women are advised to make that choice, yet there has been wholly inadequate publicity for that recommendation. I speak as the vice-chair of the all-party parliamentary group on foetal alcohol spectrum disorder. We have heard heartrending evidence of the impact of alcohol on children’s lives, including their physical and mental wellbeing. It is particularly important to note that, according to the evidence that we have heard, women’s bodies tolerate alcohol at different levels, which is why the best advice is to not drink at all during pregnancy. I challenge Health Ministers, particularly in the run-up to Christmas, to get that message out so that pregnant women hear it and can make that choice.

Alcohol harm impacts on the health not just of the individual, but of those around them. One in five children under the age of one live with a parent who drinks hazardously. Alcohol is implicated in 25% to 33% of child abuse cases, and it generates a substantial bill for UK taxpayers with regard to the impact on emergency services. The all-party parliamentary group on alcohol harm will publish a report on that on 6 December, and I am pleased that my hon. Friend the Member for Totnes (Dr Wollaston) has contributed to it. I hope hon. Members will take note of it, because alcohol abuse has a disproportionate impact not only on emergency services, but on the number of accidents and fires in the home. The report will spell that out. The charity Balance has shown that between 2014 and 2015, the rate of alcohol-related admissions in England from the most deprived decile was more than five times greater than the rate for those from the least deprived decile. That puts pressure on already burdened systems.

I want to finish with a point that now arises continually in my work on alcohol harm, namely the impact of cheap alcohol. Let me tell Members a fact that may surprise or even shock them; it shocked me when I first heard it. For the cost of a cinema ticket, it is possible to buy almost 7.5 litres of high-strength white cider, containing as much alcohol as 53 shots of vodka. Many homeless people, and many people who are in a vulnerable state in life, are drinking that product, which has been likened to a death sentence. In the hostels run by the homeless charity Thames Reach, 78% of deaths were attributed to high-strength alcohol. Not for the first time, I urge Ministers, for the sake of the health of the most vulnerable in society, to consider a minimum unit price for all alcoholic drinks. That is a targeted and effective intervention that would save lives and reduce health inequalities considerably. Potentially, according to the Institute of Alcohol Studies, eight out of 10 lives saved as a result would be from the lowest income groups.

We need better education to inform young people about the effects of alcohol harm, so that they can make better choices and so impact on their own health. We need improved alcohol treatment services because they are inadequate. More than half of drug addicts receive treatment, but only one sixteenth of alcohol dependants do. We need to invest more in recovery for those who are suffering the effects of alcohol addiction and harm. We need better and more effective alcoholism diagnosis in our hospitals and better rehab programmes. We need to support education better to help people not to fall into such difficulties in the first place.

The edit just sent has not been saved. The following error was returned:
This content has already been edited and is awaiting review.

It is a pleasure to follow the hon. Member for Congleton (Fiona Bruce), who made a number of interesting points. She made a convincing argument for introducing compulsory personal, social, health and economic education in schools. That is something that the Government could well do to foster good, healthy relationships, and it would go a long way to reducing health inequalities.

I congratulate the hon. Member for Totnes (Dr Wollaston) on securing the debate and thank the Backbench Business Committee for recognising the importance of the subject. I was pleased to hear the hon. Lady refer to drug and alcohol treatment services, as did the hon. Member for Congleton. The future of substance misuse services is in jeopardy when some local authorities face huge cuts to public health budgets and have no statutory obligation to provide such services. We need to address that when we talk about health inequalities.

I would like to add to the list something that I do not believe anyone has mentioned: the responsibility of local authorities in England to commission sexual health services. Sexually transmitted infections are increasing because cost-efficiency, rather than clinical need, seems to be the overriding factor when commissioning such services. We need to ring-fence funding for sexual health services as a matter of urgency; otherwise we face the development of a serious risk to public health.

I want to concentrate on diabetes and diabetic care, and throughout my speech I will refer to the report by the all-party group for diabetes entitled “Levelling Up: Tackling Variation in Diabetes Care”, which was launched yesterday. I declare an interest as secretary to that group. I urge everyone with an interest in diabetes care, and in health in general, to read a copy of that excellent report. We took evidence from people with diabetes, healthcare professionals and clinical commissioning groups. One theme that came out from people with diabetes was the inconsistent quality of care. I am pleased that the Government and NHS England have recognised the need for improvement in diabetes services. During the investigation, NHS England announced £40 million of funding for diabetes improvements—diabetes is one of the six clinical priorities in the improvement and assessment framework for clinical commissioning groups—and it is vital that this opportunity to transform diabetes services is taken.

Our report identified three key things that people with diabetes need and deserve: first, high-quality consultations with the right healthcare professionals; secondly, support to manage their condition; and thirdly, access to key technologies. On the first point, a big part of how people with diabetes perceive their care is determined by how healthcare professionals communicate with them. People told us that they sometimes felt that they were criticised in appointments for not meeting treatment targets and that they were being dictated to about how to manage a condition that they had to live with. Our report found that people who have an input into their own care have better treatment outcomes. Consideration of their own lifestyles alongside their diabetes management, as well as an interpretation of National Institute for Health and Care Excellence guidelines, allowed for tailored treatment plans. In this case, it seems that collaboration brings far better results than confrontation.

People also talked to us about the difficulty of getting access to specialists, with some reporting that services were simply overwhelmed. Others said that they had to seek local services proactively to get a referral. The services that patients really valued were diabetes specialist nurses, dietetics and podiatry. Additionally, people affected by diabetes also valued their pharmacists and saw how their role might be significantly expanded to provide more information and support. That might well be worth reflecting on, given the Government’s recent cuts to community pharmacy services.

On the second point, about the support given to those with diabetes to help them to manage their condition, there is a huge variation in the information and education that is provided. Those who attended structured education courses generally reported that they found them valuable and that those courses helped them to manage their condition better. However, there is huge variation in the offer and uptake of these courses. In my constituency of Heywood and Middleton, only about 20% of people with diabetes are offered these courses, and the uptake is even lower. Clearly, that health inequality needs addressing. People in work often reported the problem of getting time off work to attend a five-day intensive course, while those with children also reported that accessing childcare was a problem. There is a job of work to be done to persuade employers that they will also reap the benefits of having a happier, healthier and more productive employee if they are reasonable about allowing time off.

The third point, on access to key technologies, serves to emphasise that technology now plays a key role in diabetes care, particularly for type 1 diabetes. Again, however, patients face a postcode lottery in getting the technology they need. That was cited as a major concern by the parents of children with diabetes. Worryingly, many type 2 diabetics reported that they had to self-fund their own blood glucose meters and test strips, which are essential for the self-management of their condition. Some type 1 diabetics reported the same thing, which sounds harsh, as it is a legal requirement for diabetics on insulin to test themselves before driving, and the Driver and Vehicle Licensing Agency now advises people who take medication that causes hypoglycaemia to test themselves before driving. Similar postcode lotteries were reported regarding access to insulin pumps, and continuous and flash glucose monitoring, all of which can help diabetics to control their condition better and improve health outcomes. Sadly, inequalities in health outcomes persist because only the better-off are able to access devices that make living with diabetes easier.

The motion calls for support for policies to reduce health inequalities, and our report identified four areas the Government should look at: care and support planning; support for self-management; access to key technologies; and a strong, local diabetes system. Variation and inequality in diabetes care show us that good care can be achieved, but our task and the task of the Government is to make that happen everywhere so that best practice is shared, we end the postcode lottery in diabetes care and we tackle the diabetes crisis.

The edit just sent has not been saved. The following error was returned:
This content has already been edited and is awaiting review.

It is a pleasure to follow the hon. Member for Heywood and Middleton (Liz McInnes), who made important and serious points. I congratulate my hon. Friend the Member for Totnes (Dr Wollaston) on securing this incredibly important debate. I thank her and other Members who have participated for their work in this place to highlight this issue, and for the excellent debate that we have had.

This issue is about unequal lives and life chances. Naturally, like all Members, I take every opportunity that I can to talk about everything that makes me proud to represent my constituency, whether that is Telford’s industry, its history of innovation and enterprise, its vibrant new town, its green spaces or its high-tech businesses and jobs, all of which I have spoken about with great pride and at some length. However, sometimes, as the hon. Member for Stockton North (Alex Cunningham) so eloquently did, we must raise the issues that deeply affect the quality of life of our constituents. Those issues need to be addressed, but they are too often overlooked and glossed over, which can make those who experience these difficulties feel left behind and ignored.

Telford is a former mining area on the east Shropshire coalfield. It became a new town in the 1960s. With business, jobs and new growth it is starting to thrive in many ways, yet it retains significant areas of deprivation, with a total of 13 super output areas ranked in the 10% most deprived areas nationally. Hand in hand with areas of deprivation and disadvantage come marked health inequalities, which exist relative to both the national average and that for the west midlands, as well as—pertinently—relative to the surrounding, more affluent rural area of Shropshire. That area has more good schools, higher incomes and significantly better health outcomes, judged by any measure we might care to choose. Whether it is obesity, life expectancy or smoking rates, the outcomes are significantly better in surrounding Shropshire.

To take obesity, which Simon Stevens has dubbed “the new smoking” as a killer disease, 72% of adults in Telford are overweight or obese, which is an increase on last year’s figure and one of the highest rates in the country. That compares with a rate of 65% in neighbouring, more affluent rural Shropshire. Some 32% of adults in Telford are obese compared with 24.4% nationally; in Shropshire, the figure is 23.1%. I congratulate and admire organisations in Telford that are doing such good work to tackle that. However, the figure is continuing to increase, and we cannot ignore it—we must talk about it and take it more seriously.

I want to take this opportunity to flag up the statutory obligations of local CCGs, NHS England and the Secretary of State to address health inequalities, in particular because Telford and Shropshire continue to undergo a controversial reorganisation of future healthcare provision. The Health and Social Care Act 2012 introduced legal duties on the Secretary of State, NHS England and CCGs to reduce health inequalities and move towards greater investment in healthcare where levels of deprivation are higher. NHS guidance for commissioners says that

“health inequalities must be properly and seriously taken into account when making decisions”

and that it is necessary to demonstrate that the appropriate weight has been given to tackling health inequalities. I know from my experience as non-executive director of an NHS trust that the NHS is committed to that objective and that tackling health inequalities is at the heart of all it does, but somehow that is not happening.

It is right that decisions are made locally by local health commissioners, but we need to ensure that commissioners pay due regard to health inequalities and that they evidence the fact that they have done so. That is not about box ticking or paying lip service to an ideal.

Telford and Shropshire are in the third year of a review into the reconfiguration of the area’s healthcare provision, which includes a women and children’s centre and an A&E. While I welcome the proposed additional investment in health provision for the wider area of Telford and Shropshire, I want to be a voice for my constituents, so I want to ensure that health inequality is prioritised both in the decision-making process and when new investment is brought to the area.

As the review of Telford and Shropshire’s healthcare draws to a close after a protracted and expensive process, it has been confirmed that the preferred option is to close Telford’s newly opened women and children’s centre at Princess Royal hospital and to rebuild it in the more affluent area served by Royal Shrewsbury hospital. In addition, it is suggested that there should be extra investment in emergency care at Royal Shrewsbury hospital. My constituents are rightly concerned about that proposal. Not only is the much-needed investment to be redirected elsewhere, but Telford may lose other key services. Telford has the greatest need, the fastest growing population, as a rapidly expanding new town, and, above all, the greatest inequality of health outcomes. Too often in Telford we hear that rural sparsity is prioritised for additional investment, rather than deprivation, health inequalities and need. That is wrong.

I am pleased to have had the opportunity to raise this issue. I ask the Minister to give us assurances that addressing health inequalities in Telford, and in other areas of deprivation and need where there is a stark contrast with more affluent neighbouring areas, will be prioritised. As my hon. Friend the Member for Plymouth, Sutton and Devonport (Oliver Colvile) said, resource really must follow need.

The edit just sent has not been saved. The following error was returned:
This content has already been edited and is awaiting review.

I join colleagues across the House in congratulating the hon. Member for Totnes (Dr Wollaston) and her Committee on their work in this area and on securing this debate. She brings a calm and clear knowledge to every health debate. We really do need a long-term vision in this area and I know that she, like me, wants to see that, whatever party is in government.

I speak today both as an MP for a constituency with large gaps in health, wellbeing and life expectancy, which are very much determined by place of birth, early years experience and poverty, and as Chair of the Public Accounts Committee, which in this year alone has published 10 reports on the national health service, some of which shine a light on this debate. Our reports show the huge pressures on the national health budget and the huge increases in demand on that budget. To take diabetes as an example, 4.8% of the population is currently diabetic, but that is set to rise to 8.8% in the next few years.

It is my role and the role of my Committee to look at funding. Specifically, our role is to look at the economy, effectiveness and efficiency with which the Government spend taxpayers’ money, so I will talk first about how we spend the money that is allocated to our health service and how that is key to tackling health inequalities. I will then turn to how we look at the impact of decisions, both in the health service and in other parts of Government, on health inequalities—what we in the Committee call “cost shunting”.

NHS budget spending is in the region of £110 billion a year. The Government are keen endlessly to remind us that they have injected £10 billion into the NHS over the six-year period to about 2016. At the same time, we see an ageing population, a large and increasing demand, including for specialised services, and a health service squeezed at each step of the journey. My Committee has heard evidence on general practice, specialised services such as diabetes and neurology, acute trusts and social care, all of which has shown the impact on the budget. That has all been caught up in what, sadly, has been a rather childish debate over headline figures and often very subtle changes in language from the Government about who is to blame. Ministers have moved from the mantra, “We’ve injected an extra £10 billion”, to saying, “The NHS has been given what it asked for”, as though they were scolding a naughty child, and, “We will manage this within the NHS”, as the Chancellor said yesterday when I asked him why he had not considered the NHS budget in the autumn statement.

In today’s Daily Mail there is an exhortation—this is quoting sources close to or in Government—that the NHS simply needs to manage its resources better and cannot endlessly be given more money. I am Chair of the Public Accounts Committee. This is taxpayers’ money. I do not think we should endlessly pour money into any Department without demanding quite a lot of it, and I am clear that there are always efficiencies to be found in a system so large and with such a large overall budget. Every pound saved is a pound to spend on something else. That is the key point. Every pound saved in the Department of Health budget can be spent on other things and ought to be spent on public health in particular. I will come on to that.

As I have highlighted, there are many pressures on the NHS budget. With all these discussions and figures being bandied around, we need to take a closer look. In 2015-16, the Department’s budget was projected to have a £2.45 billion deficit. The measures used in the last financial year to balance the budget were extraordinary and one-offs and led to an unprecedented three-and-a-half-page explanatory note from the Comptroller and Auditor General alerting all of us, particularly the Department, to his concerns that those were not replicable, long term or sustainable. He reiterated that point in a Committee hearing only a few weeks ago.

I will not spend too long on the budget figures—the debate needs to move on—but I will touch briefly on the overall figures this year for acute trusts alone. From April to September, trusts overspent by £648 million and the deficit for the first six months forecast to the year end is £669 million. This trend was increased largely because of the decision in 2011 to allow for 4% efficiency savings across the NHS by the then Chancellor of the Exchequer. Everybody in the system knew that that was not realistic on a long-term basis. People knew that there would be a problem with the budget two or more years out from the crisis in the budget settlement in the last financial year, yet there is no openness in discussing how we spend money in the NHS, what we spend it on and what we focus on.

That brings me to public health. Too often, public health budgets are raided to deal with day-to-day crises and money is taken out of NHS education. The plans for service transformation are not necessarily a bad thing, but the danger is, if they are done in the wrong climate and with the wrong tone, that they are seen as an excuse for cuts. They can be so much better for patients, especially if focused on preventive work and the more efficient spending of taxpayers’ money, but too often they will be driven by financial pressures. A lot of pressure was put on finance directors of acute trusts in particular at the end of the last financial year. Many were encouraged, for example, to move capital funding into the resources side of their budget in order to balance the books—a short-term measure that can lead to underinvestment in facilities that, if invested in, can actually save money and improve the patient experience.

This short-term, year-on-year, or even spending review period planning will not tackle health inequalities effectively. We need a longer-term approach. We need to prevent more ill health and treat fewer patients. As others have highlighted, the age of death is increasing—we have an ageing population—but the age of disability remains broadly similar. Public Health England released a report towards the end of 2015 highlighting some of these figures. The cost of treating illness and disease arising from health inequalities has been estimated at around £5.5 billion a year, and then there is the issue of cost shunting, which is a big concern.

If we do not tackle these things, it will not just be individual patients or their families who suffer, or the taxpayer funding these services; there is a wider impact on society. Productivity losses are estimated at between £31 billion and £33 billion per annum. Lost taxes and higher welfare payments cost in the region of £28 billion to £32 billion per annum.

To go back to what the hon. Member for Totnes said about smoking, if we tackle tobacco issues in my neighbouring borough of Newham alone, that would save about £61 million per annum. That would make a big contribution to the local health budget in east London. If we replicated that across just east London, just think what we could contribute to the NHS budget.

About 1.3% of workdays a week are lost to sickness in London alone, which is lower than in many parts of the country. All these things contribute to our productivity gap and have a big effect, so if we are to do what the Chancellor said yesterday and ensure that our workers produce in four days what they now produce in five, we need workers who are well and can work until the increased retirement age that is demanded. It is quite shocking that the hon. Member for Glasgow East (Natalie McGarry) and other colleagues from Glasgow represent a city where people will die before the age at which they qualify for their state pension. There are certainly many people in my constituency who face that, although they are not the average. That is a sign of the failure of preventive work to tackle health inequalities at the right point.

When it comes to joining up Government, we need to look not just at the silos in various parts of the health budget, but at ensuring a healthier wider society. Let us take, on the one hand, the land disposals that the Government are undertaking to provide public land to build new homes. My Committee has looked at that a great deal, although I will not divert the House today too much. In my area we have St Leonard’s hospital, the site of a former workhouse in Hackney. When the most recent reorganisation of the NHS took place in 2011, the site was moved to the central PropCo, the property company that the NHS holds centrally to manage its estate. We therefore no longer have local control of what to do on that site. Given the state of homelessness locally, if we could provide families with more good-quality homes on that site that were not overcrowded, we would do more for public health and health inequalities than a lot of the fiddling around we do over whether a service should be based here or there and all the treatment work we are doing.

Departments are now taking account of other “strategic objectives”, as they put it, in land disposals, but that is still ill-defined. My Committee will continue to push on this matter because from the perspective of my constituency, where we have extraordinarily high house prices, if we can release land and provide homes for key workers, that would contribute to the outcomes of those Departments. I am determined that the Government are clearer in their outcomes, because in constituencies such as Taunton Deane—or perhaps not, as the hon. Member for Taunton Deane (Rebecca Pow) highlighted—the need might be for green space or other facilities that would improve or promote health. However, if we do not have a wider view of what we are doing with our public assets, there is a danger that we will just sell to the highest bidder and lose the chance for several generations, because once land is gone, it is gone.

Finally on this issue, it is important to touch on the increasing challenge of homelessness, particularly in London and in my constituency. London households in temporary accommodation now account for around three in four of all such households in England. That is not a surprise, given increasing house prices and rents, and the impact of the benefit cap, which means that people cannot now rent a three or four-bedroom home on housing benefit anywhere in London or the south-east of England. I have people coming to see me now who even five years ago, and certainly 10 years ago, would not have come to me about their housing. They were managing okay, they were living in the private sector, they were paying their rent and they were working.

Now, one woman who came to see me had lost her job because she had been ill. She had hoped to go back to work. She had a good job with professional prospects, although not a well-paid job. She became ill and her rent went up, so she fell notionally into arrears while she was trying to find another home, as her rent was no longer covered because of the housing benefit cap. She tried to find somewhere in Hackney and the neighbouring six boroughs but could find nowhere, until eventually a landlord said he would take her in on benefits. However, because of the complexities in how housing benefit is allocated, he would not take her unless he had a guarantee a month before she moved in that she would be able to receive housing benefit. However, the system does not allow for that. As a result, a woman whose health was challenged anyway was suffering mental health issues through no fault of her own.

My constituent was of course very concerned, anxious and depressed about what was going to happen in her situation, and she is just one of many. This is the worst situation I have experienced in over 20 years as an elected member at local or national level. The stress of poor, uncertain and overcrowded housing has a huge impact on health. If someone is homeless, it increases by one and a half times the likelihood of their having a physical health problem, and it makes them 1.8% more likely to have a mental health problem, although it seems to me from my experience of speaking to people face to face that those figures are underestimates. Perhaps they mask the temporary housing problem, compared with the reality of what I am seeing. This has a huge impact, focused, yes, on the absolutely poorest, but also on people such as the woman I mentioned—people who have just hit a bit of a rocky patch in their life, where something has gone wrong and caused a spiral downwards towards homelessness.

There are so many hidden households in my constituency —families living on the sofa in the living room. It could sometimes be a family of an adult and two children in that situation while another family is living in the bedroom. For various reasons, they do not qualify for council housing, or they are on the waiting list—a bit of a misnomer when people wait a lifetime for a council property. Sometimes they cannot afford, on their income, to rent privately and they have no other options.

Temporary accommodation is now costing Hackney council about £35 million a year. I commend the Hackney Gazette, which has done a lot to highlight the conditions in temporary accommodation hostels in my borough and across London. We have the Homelessness Reduction Bill, which is passing through Parliament, but that is only part of the picture. Saying that councils must accept people who are homeless is fine, but unless we have the homes available to provide to those people at an affordable level, we will not solve this problem.

The edit just sent has not been saved. The following error was returned:
This content has already been edited and is awaiting review.

I believe that the Government provided £10 million yesterday for homes, particularly in London, so things are being done and they are on the move. I just wanted to put that on the record.

The edit just sent has not been saved. The following error was returned:
This content has already been edited and is awaiting review.

The hon. Lady pre-empts my next point. I welcome the fact that the Government have begun to make some moves on housing, particularly taking away the “pay to stay” provisions. I am making sure that all my local housing associations are not going to buy into this on a voluntary basis—I hope they would not in London. The autumn statement freed up housing associations to use Government money for affordable housing as defined locally, rather than as set nationally. The idea that in my constituency affordable would be 80% of private rents is nonsense; it is well out of the range even of people who are well above the minimum wage. Most young people in Hackney share a home, because they could never afford to rent somewhere privately and they certainly cannot get on the housing ladder. It is going to take a generation to solve this housing problem, so although I welcome what the Government have done, much more could have been in their six years of office.

I am pleased that we now have a Housing Minister who is a London MP and who understands London issues. We London Members often speak about housing here, and it is as though we are in a different world from others. However, we have this very big problem of homelessness, overcrowding and excessive use of temporary accommodation.

Let me finish with a story that should never be true in our world. It is a story of a woman who was living with her toddler and her husband in a hostel because she was waiting to get some council housing. Even three years ago, I used to say, “Hold on and hang on in there for six months, and we’ll find a home for you.” Nowadays, it is increasingly a year or 18 months. The woman went into hospital to give birth and had to come back, with her new-born baby, her toddler and her husband, to that one room in the hostel. The people living in that hostel are among the most vulnerable—not an ideal environment in which to bring children home. Many people with a lot of problems are crowded into one place, without the support they need. This is not, I am sure, what any Member wants to see. We must tackle the issue, because the health problems that that spins off for the next generation of children are immense. I add a plea from my local constituency perspective as well as from my national perspective as Chair of the Public Accounts Committee—tackling homelessness is a vital issue to tackling health inequalities.

The edit just sent has not been saved. The following error was returned:
This content has already been edited and is awaiting review.

I am proud to participate in this debate, and I am glad that the Chair of the Health Select Committee, the hon. Member for Totnes (Dr Wollaston) has brought it before the House today. This debate is an important one, in which I have a considerable interest.

The issue of health inequalities was one of the first that I got interested in as a teenager. Sitting in my modern studies class in Lanarkshire, I could not understand why any Government would allow people in less well-off areas to disproportionately suffer ill health and die prematurely. I was frustrated when I read about the Black report and the inverse care law. I was angry then, and I am angry now that the political decisions taken here are the root cause of that mortality and morbidity that still blights too many lives in our country today. It is unacceptable that male life expectancy in parts of Glasgow should vary by 15 years, between the ages of about 66 and 81. In the case of women, the gap is 11 years. I got interested in politics because I wanted to change that: I wanted to understand why it was, and I wanted to know what I could do to help.

I joined the SNP when I was at school. I know that today’s debate has not been too party political, but I think it is important to put this on the record, because it is important to me. I joined the SNP because I could see that the health of Scotland’s people in particular was not a priority at Westminster. When I was at school there was no Scottish Parliament, and there was no way in which we could deal with the issue ourselves.

The hon. Member for Stockton North (Alex Cunningham) mentioned the Black report. The way in which that report was greeted was quite telling, as is the fact that we are still discussing many of the issues now. The Marmot report has not yet been implemented, and the obesity strategy is still not as strong as it could be. It has not been possible to tackle the underlying causes of health inequality, but I believe that if the Scottish Parliament had all the powers of a normal Parliament, we would be able to deal with them more adequately than they have been dealt with in the past. [Interruption.] Some members may disagree with me, but that is what I believe. It is past health inequality that we are dealing with now, because there is a time lag.

The edit just sent has not been saved. The following error was returned:
This content has already been edited and is awaiting review.

I do not disagree with the hon. Lady, but I think she must have misinterpreted my action. It was my right hon. Friend the Member for Kingston upon Hull West and Hessle (Alan Johnson) who mentioned the Black report, and I was indicating him. No offence was meant.

The edit just sent has not been saved. The following error was returned:
This content has already been edited and is awaiting review.

My apologies. I had to nip out to the loo earlier, and I must have got my wires crossed. I thank both Members for raising those issues. It is important for us to think about the context of the debate and where we are going.

I have been reading the report to which the hon. Member for Glasgow East (Natalie McGarry) referred. I pay credit to the in-depth work and dedication of the Glasgow Centre for Population Health. Its director, Dr Carol Tannahill, along with Bruce Whyte and David Walsh, lead much of that work. Along with their team of researchers, they have laid out the history of health inequality in Glasgow and in Scotland more widely. They have done a huge amount of research, and have come up with not only history, but some solutions.

In 2007, when I was first elected as a Glasgow councillor, the centre’s most recent report was “Let Glasgow Flourish”, but since then it has carried out a great deal of research on Glasgow’s “excess mortality”. It is interesting to note that that excess mortality applies across different causes of death, and across ages, genders and social strata, although it is most pronounced in members of the working-age population living in the poorest neighbourhoods, where the impact of alcohol, drugs and suicide, particularly among men, is stark. In comparison with Manchester and Liverpool, Glasgow experienced an extra 4,500 deaths between 2003 and 2007. In Scotland overall, there were an extra 5,000 deaths in each year between 2010 and 2012.

I shall not repeat what was said by the hon. Member for Glasgow East, but it is important to note that Governments knew that that was happening. The impact of their policies was known. Urban change, particularly in Glasgow, was taking place in a noticeably different way from the way in which it was happening in Liverpool and Manchester. It had a disproportionate effect on the population, and we still see the lag of that today. One of the reports produced by the Glasgow Centre for Population Health quotes from a 1971 Scottish Office report called “The Glasgow Crisis”, which noted that

“Glasgow is in a socially…economically dangerous position.”

However, nothing was done at the time. The urban regeneration in Glasgow took place in the shopping centres in the middle of the town, but did not touch the areas that needed it most.

Poverty and health inequality are incredibly difficult to turn around. They cannot be fixed by a sugar tax or any other individual health measure; a wide-ranging approach is required from all levels of government. Glasgow has worked incredibly hard, and has established a poverty leadership panel to examine some of the issues. The Scottish Government have invested heavily, and have set up a ministerial taskforce on health inequality. However, we must keep working harder and working together if we are to achieve a result.

Clyde Gateway is an urban regeneration company in my constituency. Members may wonder whether an urban regeneration company, which builds things and fixes the ground conditions, should be interested in health, but the company has been working for eight years in Glasgow and Rutherglen, and has learnt lessons from previous regeneration efforts. So far, it has managed to lower the claimant count for out-of-work benefits from 39% to 28% and the claimant count for jobseeker’s allowance from 8.6% to 4.8%. That is pretty remarkable in itself, but the company cannot go any further until it starts to tackle the underlying health issues that are keeping people out of work. It is therefore working closely in partnership with local organisations and local people. It is crucial that local people are part of the process and are not having things done to them, as was the case before. They are now part of the solution and the community is a part of what is happening.

Clyde Gateway recently signalled its intention to seek a means of tackling health inequalities. It wants to work to improve diet and cancer screening, which are both factors in the area’s ill health. There is a lot of worrying evidence that people in areas of deprivation are not taking up the screenings to which they are entitled. Those screenings include tests for cancer and free eye tests, which can also be an indicator of other conditions. I spoke to the Royal National Institute of Blind People yesterday about early intervention and the importance of people going for their eye tests. Clyde Gateway also wants to grow jobs in health and social care in the local community to make people working in the industry part of the community as well, rather than having staff coming in from other areas to “do” health to people.

I wholeheartedly agree with the notion that public health ought to be everybody’s business. It is not just for public health officials to do on their own, because the roots of health inequalities are to be found in income inequalities. So in Scotland we are tackling some of the underlying causes. The living wage uptake in Scotland now far exceeds the uptake in other parts of the country. We are supporting families and helping to improve the physical and social environment and housing. We have invested heavily in housing, because much of the ill health was coming from housing that was damp and substandard. Housing was making people ill and was not being tackled.

We have increased free school meals and continued commitments such as free prescriptions, concessionary travel and free personal care. The hon. Member for Bradford South (Judith Cummins) talked earlier about tooth-brushing and the rates of tooth decay. In the mid-1990s, when I was starting secondary school, just under 40% of children in primary 1 in Scotland—those just entering school—had no dental cavities. That figure is now just under 70%, which is pretty good and marks quite a shift, but we need to go a lot further. Initiatives such as Childsmile, through which all children in Scotland regularly get free toothbrushes and toothpaste, are helpful.

As the hon. Members for Totnes and for Congleton (Fiona Bruce) mentioned, a lot of work is being done on minimum unit pricing to reduce alcohol consumption and deal with many of the issues that lead to people buying low-price cheap alcohol, which is killing them. We have reduced smoking rates, too, by bringing in the smoking ban first, and we are doing a lot of work to encourage active living and healthy eating, and investing to improve mental health services.

As chair of the all-party group on infant feeding and inequalities, I want to take this opportunity to speak about breastfeeding and the impact it can have on health inequalities. James P. Grant, executive director of UNICEF during the 1980s, said that

“exclusive breastfeeding goes a long way towards cancelling out the health difference between being born into poverty or being born into affluence. It is almost as if breastfeeding takes the infant out of poverty for those few vital months in order to give the child a fairer start in life and compensate for the injustices of the world into which it was born.”

That is quite a statement.

Sadly, there is a huge inequality in breastfeeding, particularly in the UK. Women in areas of greater deprivation are far less likely to breastfeed. They are then also often paying for expensive formula milk, which will put a strain on their family budget.

I was once told by a Labour councillor in Glasgow that in his experience there was an inverse perverse stigma: if a woman breastfed, it made her look as though she was too poor and could not afford the formula. The cost is a big issue, however, as I highlighted in my ten-minute rule Bill last week.

Families are being penalised for a societal problem: the UK just does not provide enough support, via midwives, health visitors, peer supporters and local networks, to ensure that mums are able to breastfeed for as long as they want to. Some of the economic agenda is having an impact on those important services, and coverage is fraying, as volunteer services find it harder to cope. It is seen as difficult, and there is so much blame and shame for mums, whatever they do and however they feed their children.

Many younger women have never seen anyone breastfeed. There is also interesting evidence from Sally Etheridge that the longer that black and minority ethnic women who have come to the UK from other countries stay here, the lower their breastfeeding rates become as they begin to assimilate into our bottle-feeding culture. I believe that there is a lot we can do to improve this situation and encourage the Government in that regard. I met the Minister earlier this week and am glad that she is listening and keen to address the breastfeeding rates across the country.

The series on breastfeeding from The Lancet and the UNICEF report on preventing disease and saving resources point out that the NHS could save significant amounts of money by investing in breastfeeding services. They reckon that there would be 3,285 fewer hospital admissions for gastrointestinal issues and 5,916 fewer admissions for respiratory tract infections, which could save £10 million across the country. That is no mean feat. There would also be connected reductions in obesity and sudden infant death syndrome, as well as a reduction in breast and ovarian cancer in the mum. Breastfeeding is a significant public health intervention, as the UNICEF call to action has illustrated.

I should like to summarise a few of the suggestions in the Glasgow Centre for Population Health report, as it is the purpose of our debate today not only to look at the problems. Health interventions on smoking, alcohol and so on have helped, but the report has found that the main means of resolving health inequality is not a health intervention but a wealth redistribution. A widening gap in income has been perpetuated by different Governments over many years. Fair and progressive taxation and fair wages would make a huge difference to the gap. Ensuring that all people have a sufficient income is critical, yet this Government continue to slash social security spending, which is making people not only poor but ill.

An NHS Health Scotland report published this month said that a quarter of lone parents in Scotland rated their health as either fair, bad or very bad. Those parents have to look after children. If their health is fair, bad or very bad, they will not be able to be effective parents. The impact of food banks on health is also clear. If people cannot afford to put food on the table, they have to resort to going to a food bank to get canned meals. They do not get fresh food and vegetables; they get something out of a can that they might not even be able to heat. That will have an impact not only on their physical health but on their mental health.

The GCPH report looks at the cost of living and at how we as a society can support people to live with dignity and live a life in which they have choices. Having choices in life should not be a luxury. If someone does not have any control over what happens to them in life, it will have a huge impact on them and their family for years to come. The report also recommends affordable, warm and appropriate housing. As the hon. Member for Hackney South and Shoreditch (Meg Hillier) said, not having somewhere affordable and warm to live can have a huge impact on people. We need to learn from past mistakes and look more widely at the policies we pursue and the things that we in this House think are important, because they can have long-lasting effects, as we have seen in Glasgow.

Most significant to all of this is the adoption of the World Health Organisation’s principle of including health in all policies. This must run through absolutely everything that the Government do, because of the impact on health. Yesterday, the Chancellor failed to address health spending; indeed, he failed to address the question of health at all. He is failing the people of this country by not acknowledging the significance of health to everything else that the Government wish to achieve.

The edit just sent has not been saved. The following error was returned:
This content has already been edited and is awaiting review.

I welcome the opportunity to speak in the Chamber for a second time today, on yet another important topic. This time we are debating health inequalities and I thank the Backbench Business Committee for allowing this debate to take place following the application by the hon. Member for Totnes (Dr Wollaston) and other hon. Members across the House. The hon. Lady made an excellent speech, and we are very grateful to her for that. I also want to thank other hon. Members across the House for their excellent contributions today. I especially want to highlight the excellent speeches by my right hon. Friend the Member for Kingston upon Hull West and Hessle (Alan Johnson) and my hon. Friends the Members for Stockton North (Alex Cunningham), for Bradford South (Judith Cummins), for Heywood and Middleton (Liz McInnes) and for Hackney South and Shoreditch (Meg Hillier).

I enjoyed the speeches by the hon. Members for Plymouth, Sutton and Devonport (Oliver Colvile)—a fellow member of the all-party parliamentary group on basketball—and for Erewash (Maggie Throup), who made an excellent speech on obesity and childhood obesity. I also enjoyed the speech by the hon. Member for Glasgow Central (Alison Thewliss). As she knows, I agree with most of what she says, especially about breastfeeding. We have had an excellent debate, with excellent contributions all round.

When it comes to addressing health inequalities, there are many conversations about the need for systemic change to reverse the trends. However, I want to look at tangible specifics that the Minister can get to work on in her remit as Minister for public health. I will do that by looking at the current state of health inequality and then the two key areas of smoking and childhood obesity and what more can be done to address those signifiers. I will then move on to the cuts to public health grants, which are exacerbating the situation.

The most recent intervention on health inequality came from the Prime Minister, who used her first speech on the steps of Downing Street to highlight that,

“if you’re born poor, you will die on average 9 years earlier than others.”

We have heard clear examples of that from constituencies around the country. That welcome intervention set the tone of her Government’s serious work to address health inequalities.

It is hard not to agree when the facts speak for themselves. Two indicators from the most recent public health outcomes data show that London and the south-east have the highest life expectancy while the north-east and north-west have the lowest. The same pattern appears when looking at excess weight in adults, which we have also heard about today. Rotherham comes out the highest at 76.2% and Camden is the lowest at 46.5%. Those figures prove what we all know to be true: people living in more deprived parts of the country do not live as long as those in more affluent areas. Contributors to ill health such as smoking, excessive alcohol consumption—which we heard about from the hon. Member for Congleton (Fiona Bruce)—and obesity are more prevalent in deprived areas.

There is a moral argument that it is important for the Government to address such issues, so that we can improve our nation’s health, but there is also an economic argument to be made. If we have an unhealthy population, we will not be as productive. In England, the cost of treating illnesses and diseases arising from health inequalities has been estimated at £5.5 billion a year. As for productivity, ill health among working-age people means a loss to industry of £31 billion to £33 billion each year. Those two arguments must spur the Government into action, but there are many issues to tackle and multiple ways for the Government to address them. Many such issues have been raised in the debate but, as I said, I will examine two key areas that the Minister must get right: smoking cessation and childhood obesity.

My first outing as shadow Public Health Minister was to debate the prevalence of tobacco products in our communities and the need for the Government to bring forward the new tobacco control plan.

The edit just sent has not been saved. The following error was returned:
This content has already been edited and is awaiting review.

indicated assent.

The edit just sent has not been saved. The following error was returned:
This content has already been edited and is awaiting review.

The Minister remembers it well. The Government need to set out key actions to work towards a smoke-free society. Smoking is strongly linked to deprivation and has major impacts on the health of those who do smoke, such as being more prone to lung cancer and chronic obstructive pulmonary disease and facing higher mortality rates. If we look at that by region, which I have already established is a factor in health inequality, smoking levels are higher in the north-east at 19.9% compared with the lowest in the south-east at 16.6%. When looking at smoking by socioeconomic status, we find that the smoking rate in professional and managerial jobs is less than half that in routine and manual socioeconomic groups, at 12% and 28% respectively.

In the debate held just over a month ago, the Minister was pushed on when the new tobacco control plan would be published. Concerns have been raised by various charities, including ASH, Fresh NE and the British Lung Foundation, about how the delay could jeopardise the work already done. Sadly, the Minister evaded my specific question back then, so I will ask her the same thing again: when can we expect the new plan? Will it be this year or next year? The plan will not only go a long way to work towards a smoke-free society, but help to reduce health inequalities in our deprived areas. The Minister can surely understand that and the need to come forth with the plans.

The Minister knows that I also take a keen interest in childhood obesity. She has said repeatedly that the publication of the childhood obesity plan was the start of the conversation. Childhood obesity is the issue on everyone’s lips right now as it is the biggest public health crisis facing the country. I will not repeat the stats we all know about the number of children who start school obese and the number who leave obese—they are shocking. Many organisations and individuals, including Cancer Research UK, the Children’s Food Trust and Jamie Oliver, have made clear their dismay at the 13-page document that was snuck out in the summer and have said that it did not go far enough. Incidentally, it came out on the same day as the A-level results, so it looked like it was being hidden.

Obesity-related illnesses cost the NHS an estimated £5.1 billion a year, and obesity is the single biggest preventable cause of cancer after smoking. It is also connected to other long-term conditions such as arthritis and type 2 diabetes. When obesity is linked with socioeconomic status, we see real concern that the plan we have before us will not go far enough to reverse health inequality. National child measurement data show that obesity among children has risen, and based on current trends there could be around 670,000 additional cases of obesity by 2035, with 60% of boys aged five to 11 in deprived communities being either overweight or obese. There is a real need for the Government to come to terms with the fact that many believe the current plan is a squandered opportunity and a lot more must be done. That is why I hope the Minister will be constructive in her reply to this debate, giving us reassurances that move us on from this being “only the start”. At the end of her speech, the hon. Member for Erewash gave us a list of four or five items that we could start straightaway, which would certainly take us further on.

The Government have stalled or not gone far enough on the plans I have mentioned, but there is also deep concern that the perverse and damaging cuts to public health spending will widen the health inequality gap. The Minister knows the numbers that I have cited to her previously, but I will cite them again, even after my right hon. Friend the Member for Kingston upon Hull West and Hessle has done so. We are greatly concerned about the £200 million cut to local public health spending following last year’s Budget, which was followed by the average real-terms cut of 3.9% each year to 2020-21 in last year’s autumn statement. I want to add some further concerns that go beyond those raised by Labour.

Concerns were identified in a survey by the Association of Directors of Public Health, which found that 75% of its members were worried that cuts to public health funding would threaten work on tackling health inequalities. Those concerns are backed up by further evidence published by the ADPH, which found that local authorities are planning cuts across a wide range of public health services, because of central Government cuts. For example, smoking cessation services saw a 34% reduction in 2015-16, and that will become 61% in 2016-17, with 5% of services being decommissioned. That is seen across the board among local public health services and will be detrimental to reversing health inequalities. For the Government to fail to realise that cutting from this important budget will not help the overall vision on health inequality, set out by the Prime Minister earlier this year, is deeply worrying and shows a distinct lack of joined-up thinking around this issue.

In conclusion, health inequality is a serious issue that we cannot ignore or let the Government get wrong, as the health of our nation is so important, not only in a moral sense, but economically. I know the Minister will fully agree with the Prime Minister’s statement from earlier this year—there is no second-guessing that, as we all do—but we need radical proposals that get to the bottom of this persistent issue, which blights the lives of so many people living in our most deprived communities. We all want to see a healthier population, where nobody’s health is determined by factors outside their control, and we must all work together to get to the point where it is no longer the case that the postcode where somebody is born or lives determines how long they will live or how healthily they will live that life.

The edit just sent has not been saved. The following error was returned:
This content has already been edited and is awaiting review.

I congratulate the Chair of the Health Committee, my hon. Friend the Member for Totnes (Dr Wollaston), on her characteristically thoughtful opening of this debate. I thank the Backbench Business Committee for agreeing to the debate, which has been not only highly informed, but very wide ranging. I will therefore start by apologising for the fact that I will not be able to comment in detail about all the points raised, but I will reply in writing where I am not able to respond. Colleagues are right to say that the Prime Minister has made this issue a national priority, so it is not surprising that the Government share the commitment of the House to having an effective cross-Government policy that will reduce health inequalities.

We are recognised as world leaders in public health, and that has been achieved by avoiding the temptation to put health inequality in a silo. Marmot, as many have pointed out, is clear that an approach to treating health alone will not tackle what we here know are some of the most entrenched problems of our generation. We have avoided a health-only approach in the past, which is why the Chancellor’s autumn statement yesterday announced important and relevant measures such as raising the national minimum wage, raising the income tax threshold and providing, as the hon. Member for Hackney South and Shoreditch (Meg Hillier), the Chair of the Public Accounts Committee, rightly observed, an additional £1.4 billion to deliver 40,000 extra affordable homes. That provision is in addition to the Homelessness Reduction Bill.

It is right that we also look to the work of industry and non-governmental actors. I am pleased to say that the food and drink industry has made progress in recent years. Its focus under voluntary arrangements has been on calorie reduction. Billions of calories and tonnes of sugar have been removed from products, and portion sizes have been reduced. Some major confectionary manufacturers are committing to cap single-serve confectionary at 250 calories, which is an important step forward. As my hon. Friend the Member for Erewash (Maggie Throup) mentioned, some retailers have played their part by removing sweets from checkouts, while others have cut the sugar in their own-brand drinks. We welcome that and urge others to follow suit. The challenge to industry to make further substantial progress remains. We should praise those who have had success, but we will continue to challenge those who lag behind.

Colleagues are right to highlight the importance of employment, and it is encouraging to see that some gaps are narrowing. As the Chancellor said yesterday,

“over the past year employment grew fastest in the north-east…pay grew most strongly in the west midlands, and every UK nation and region saw a record number of people in work.”—[Official Report, 23 November 2016; Vol. 617, c. 900.]

But there are still some who are left behind, which is why our health and work Green Paper is specifically focused on driving down the disability work gap for those who wish to work. It is this emphasis on the social, economic and environmental causes of inequalities that convinces me that public health responsibilities as they are traditionally understood do rightly sit in local government, where national action can be reinforced and resources can be specifically targeted at pockets of inequality within local populations.

Let me respond to the concerns raised by my hon. Friend the Member for Plymouth, Sutton and Devonport (Oliver Colvile) about his GP practices. When a GP practice closes, NHS England has a responsibility to make sure that patients still have access to services and are not misplaced. I am pleased to hear that he is making some progress on the matter, but if he finds that he reaches a roadblock, I will be happy to raise his concerns with the Under-Secretary of State for Health, my hon. Friend the Member for Warrington South (David Mowat), who has responsibility for community health.

Although, as a number of colleagues have said, councils have had to make savings and are acting in tough financial circumstances, they are still accessing £16 billion over the next five years from their public health grant. They have shown that good results can be achieved while efficiencies are found and the greatest effect is generated. There are a number of examples of outstanding practice to which we should pay tribute today. The HIV innovation fund, for example, which is funded by Public Health England in collaboration with local government, provides funding for services that meet local needs and offers the most at-risk populations free, reliable and convenient alternatives to traditional HIV testing. That is happening at a time when driving up HIV testing is a key public health priority.

As my hon. Friend the Member for Totnes rightly noted, however, we must focus on key determinants such as obesity, smoking, suicide and alcohol. That is the core of the challenge that we face, which is why we are working closely with our partners in the NHS, PHE, local government and schools to deliver the childhood obesity plan. That subject has been raised by many speakers today and I assure the House that the delivery of the plan has started. We have consulted on the soft drinks industry levy and launched a broad sugar reduction programme. Those measures will have a positive impact, particularly on lower income groups, which are disproportionately affected. As many colleagues have mentioned, the measures will have secondary benefits, such as better dental health and diabetes prevention.

As was mentioned by my hon. Friends the Members for Erewash and for Taunton Deane (Rebecca Pow), it is particularly important that we focus on effectively delivering a key plank of that obesity plan: the hour of physical activity every day. One of the ways in which we will make sure that is delivered effectively is by introducing a new healthy rating scheme in primary schools to recognise the way in which they deliver this and to provide encouragement. I believe that we have delivered the right approach to secure the future health of our children, but I am determined that we will implement it quickly and effectively, and I am very happy to enter into discussions about how we make sure that that implementation works.

I entirely agree with hon. Members on both sides of the House that mental health must not be forgotten when we are discussing health inequalities. We have made progress, but parity of esteem must be more than just a phrase; it must be backed by increased funding and effective reform. That is why we are investing an additional £1 billion every year by 2020 to help 1 million more people with mental illness to access high-quality care, including in emergency departments, as well as putting in place a record £1 billion of additional investment in children’s mental health. That money is funding every area in the country. We are working hard to make sure we drive these reforms to the frontline, including, as my hon. Friend the Member for Totnes said, by refreshing the suicide strategy with a particular focus on the alarming figures for suicides among young men and for self-harm.

There can be no complacency about the scale of the challenge, as the figures quoted today forcefully remind us. We know that inequalities can be stubborn to tackle. Variations in smoking rates, particularly in pregnancy, persist, and concerted efforts are required to tackle that. That is exactly why I am prioritising the tobacco control strategy so that we can use our combined efforts to target vulnerable groups, including pregnant women, mental health patients and children, and reduce those differences, not least by supporting local areas to use data effectively to understand how best to target their policies.

The edit just sent has not been saved. The following error was returned:
This content has already been edited and is awaiting review.

Can the Minister offer us a timescale for the tobacco strategy?

The edit just sent has not been saved. The following error was returned:
This content has already been edited and is awaiting review.

I cannot, because I am not yet satisfied that it is as effective as I want it to be.

In addition, I am pleased with the action we have taken to introduce standardised packaging for cigarettes and other legislative measures. We have also launched the world’s first diabetes prevention programme, as mentioned by the hon. Member for Heywood and Middleton (Liz McInnes), and we had a very good debate just yesterday about how we can improve diabetes care. We also have one of the most effective immunisation programmes in the world. That shows our commitment to take firm action where the evidence guides us, but as I have said, that action must be cross-government, at both a local and a national level.

Our job is to put prevention and population health considerations at the heart of everything we do, as the five year forward view makes clear. Devolution deals are giving local areas more control over many of the social determinants of health, such as economic growth, housing, health and work programmes, and transport. The focus on integrated public health services within devolution promises to remove many of the structural barriers to prevention that we have discussed today, and it makes public health everyone’s business, exactly as the SNP spokesman, the hon. Member for Glasgow Central (Alison Thewliss), said.

However, with devolution, to which the right hon. Member for Kingston upon Hull West and Hessle (Alan Johnson) referred, and as we move towards business rates retention, transparency will be ever more vital to ensuring that public health outcomes improve. That is happening, but we need to go further, and we need to do more to engage local people and their elected councillors in highlighting the unjustifiable inequalities that persist. Ensuring that transparency translates into accountability is a key priority for me, and I assure the House that I am actively involved in this matter.

Members on both sides of the House are right to launch this challenge today, and I take fully on board their suggestions of how we can collectively reduce health inequalities. However, I hope that I have made it clear that the only way we are going to make progress on this issue is to adopt a whole-Government, whole-society approach. We have to constantly remind ourselves that reducing these inequalities is for not just the NHS or Public Health England, but the whole of Government, as well as local areas, industries and, indeed, all Members of this House. Today I reaffirm my commitment to work together with the widest range of partners, inside and outside Government, to make progress on this agenda. I hope that every Member here will do the same, because we owe our constituents nothing less.

The edit just sent has not been saved. The following error was returned:
This content has already been edited and is awaiting review.

I thank colleagues on both sides of the House for the extraordinary number of thoughtful contributions to this debate. As we have heard, this issue is everybody’s business, and what we now want is to see the Government translate the ambition and words into action.

Question put and agreed to.

Resolved,

That this House calls on the Government to introduce and support effective policy measures to reduce health inequality.