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Austerity: Life Expectancy

Volume 639: debated on Wednesday 18 April 2018

I beg to move,

That this House has considered austerity and changes in life expectancy.

It is a pleasure to serve under your chairmanship, Mr Paisley. Life expectancy is the statistical analysis of that most basic feature of health, life itself. Through these linear annals, since the early years of Queen Victoria’s reign, the health and wellbeing of this nation have been catalogued. Life expectancy serves as the statistical testimony of the social history of our country. Through it are revealed the national crises and epidemics, the giant leaps forward in public health and the great workplace, environmental and social reforms that have marked the last two centuries of change.

In the first collection, published in 1841, the English life table gave female life expectancy as 41 years and male as 40. The changes that followed in the subsequent 180 years have seen those doubled. The turn of the 20th century saw a dramatic drop in infant and childhood mortality as sanitation and living standards improved. Improvements in the treatment of infectious disease, the creation of the NHS, the Clean Air Act 1956 and improvements in maternity care, living standards and incomes followed, and with them rises in life expectancy that were sustained for almost a century. Neither wars nor global convulsions could stem the inexorable upward rise.

That was the great era of a remarkable revolution in public health. By 2011, women’s life expectancy had reached 83 and men’s 79. With three months added with each passing year, a little girl born in Sheffield in 2011 had every right to expect to live to be 100 years old. Those assumptions were not based on any great improvements or medical discoveries, but simply on the fact that our health was improving and would continue to do so.

However, since 2011, something unusual and, in modern British history, unprecedented has happened to life expectancy: it has flatlined. For the first time in well over a century, the health of the people of this nation has stopped improving. It is of course axiomatic that life expectancy cannot increase forever, and that a slowdown in growth would eventually occur, but it is the sudden and sustained rise in mortality rates that has so concerned public health professionals and should concern us as parliamentarians.

The period from July 2014 to June 2015 saw an additional 39,074 deaths in England and Wales, compared with the same period the previous year. While mortality rates fluctuate year on year, that was the largest rise for nearly 50 years, and the higher rate of mortality was maintained throughout 2016 and into 2017. Provisional figures on the number of weekly deaths indicate that winter mortality was higher than usual in early 2015, 2017 and 2018.

Those recent trends contrast starkly with the long-term decline in age-specific mortality rates throughout the 20th and 21st centuries. Now, research published in The BMJ has revealed the shocking fact that 10,000 more people died in the first seven weeks of 2018 than in the same period in 2017. The study finds no external factor that might have caused the 11% rise: no unusual cold snap, natural disaster or flu outbreak outside normal expectations. The Office for National Statistics has gone so far as to revise down its official life expectancy projections by almost a whole year, compared with the projections of just two years ago. That means 1 million further earlier deaths are now projected over the next 40 years.

The Financial Times has reported that the deceleration of previous rises in life expectancy has cut £310 billion from future British pension fund liabilities. As Professor Danny Dorling of the University of Oxford has noted, what is happening with life expectancy,

“is no longer being treated as a temporary decline; it is the new norm.”

Dorling and Dr Hiam have looked at other extraneous factors to explain those projections. A rise in birth rates? No—birth rates are falling. More migration? The ONS now projects less inward migration over the next 40 years.

How then to explain an increase of 40,000 deaths on what was projected for this year, and an extra 25,000 deaths for next year? We can only conclude that there has been a sharp deterioration in the collective health of this country. Dominic Harrison, Director of Public Health for Blackburn and Darwen, and an adviser to Public Health England, has said that the figures are a “strong and flashing” amber light that,

“something is making the population more vulnerable to avoidable death.

We know that in some areas the picture is even more concerning, with higher death rates and life expectancy falling. Research has pinpointed 29 areas where we see falling life expectancy for women; chief among them are seaside towns and post-industrial areas.

I congratulate my hon. Friend on securing this important debate. Barnsley, the area I represent, has one of the lowest life expectancies in the country. Does she agree that post-industrial towns such as Barnsley need more funding and resources to tackle the inequality between north and south?

I could not agree more with my hon. Friend. She makes an important point, because it is exactly those post-industrial towns and regions that were invested in so heavily under the last Labour Government and have seen a fall in life expectancy over the last seven years.

Regional and class inequalities in health, as we know, are nothing new, but there is a more distinct change now taking place. In my city of Sheffield, the healthy life expectancy for women of 57.5 years has dropped by four years since 2009, while healthy life expectancy across the country has basically held steady. There are already too many areas in our country where healthy life expectancy is unacceptably low. The average baby girl born in Manchester between 2014 and 2016 will live to be 79, but only until age 54 will she be healthy. That is almost one third of her life spent grappling with health issues that will not affect the average woman born on Orkney until she is 71 years old.

One of the factors, if not the sole factor, is that when we look at the past recession, most of the burden has been inflicted on women generally. We all know that. That is an anxiety factor, and there are good examples of it. One good example is the women of the Women Against State Pension Inequality Campaign. A lot of them were due to retire and had plans; those plans have gone now, because they will not get their entitlement. There are a number of factors that affect women more than men, particularly during a recession.

My hon. Friend is absolutely right. It has particularly hit older women, and I will come on to that disproportionate impact shortly.

Something is adversely affecting the health of our population, and as my hon. Friend has just said, none of it is happening in a vacuum. The observation is unavoidable that these patterns coincide with the era of austerity. It is simply inconceivable that the state of our public realm, welfare system, housing, fuel poverty, child poverty and our NHS have nothing at all to do with it. The number of NHS trusts with budget deficits has increased sharply since 2015, as have waiting periods for elective surgery and waits for urgent care. Hospitals are now warning of an “eternal winter”, as records show the number of patients receiving urgent care within four hours fell to a record low in March 2018. Almost half a million patients waited longer than 18 weeks for planned care.

This week, the Royal College of Physicians raised the alarm, writing to hon. Members to tell us that hospitals are “underfunded, underdoctored, overstretched”. That will not be news to anybody who has been anywhere close to the NHS in recent years. However, the shortage of doctors and consultants revealed by the RCP is systematic and shocking; 43% of advertised consultant posts last year in Yorkshire and the Humber were not appointed to. In acute medicine, only five out of 26 posts were successfully appointed to. The RCP concludes that these workforce shortages have direct implications for patient safety. Although our hospitals still provide expert care, relentlessly drawing on the good will of staff—who cannot possibly provide the best possible care when under such pressure—is unsustainable.

Issues within the NHS are being compounded by problems with the provision of adult social care. According to the King’s Fund, in 2016-17 there were 380,000 cases of a delayed transfer of care due to patients’ awaiting a hospital assessment. A similar number were waiting for a place in a nursing home. It is little surprise that the sorry state of our social care system should be linked to a fall in the life expectancy of older women living in the poorest parts of the UK, because that cohort has seen a disproportionate fall in their life expectancy. For the first time, health inequality is rising because the most deprived are suffering with poorer health.

I have often heard it said that the elderly have been protected from the worst ravages of austerity, but the elderly who live in deprived communities have been hit many times over. Relevant to this debate, they have been hit first by the cut in pension credit for lower-income groups and then through the funding pressures on adult social care. Of course, it is in the local authorities serving the most deprived areas that these effects have been felt the most.

My hon. Friend is making an excellent speech, especially on the impact on the elderly. However, does she agree that more and more children are now being impacted by austerity? Slough Foodbank has noticed an increase in the number of families attending its food bank, saying:

“When we checked the vouchers, we discovered that there had been an increase of 16% in the number of children we helped in 2017 compared to 2016.”

Does my hon. Friend agree that it is important that child poverty is addressed now? There are lifelong implications for those who grow up in poverty, such as poorer academic results, employment prospects and life expectancy.

I am glad that my hon. Friend raises that important point, because I am not able to address all the factors behind declining life expectancy. The British Medical Association raised that point this week, saying it is very concerned about the 5 million children growing up in poverty and the implications that that will have in the future on life expectancy.

I do not want to divert my hon. Friend from the main course of her speech, but she knows that, over the past 30 years, infant mortality has fallen by 60%, yet from 2015 onwards it has risen in England and Wales each year. Holywell Central and Flint Castle wards in my constituency have child poverty rates of 43% and 42%. We have seen an increase of 100 children in poverty in my constituency in the last year. This is a long-term issue, which we need to address.

My right hon. Friend is absolutely right: these are long-term issues, which need addressing. They are all the more heartbreaking because we have seen decades of progress, and we all assumed that that would only go in one direction; little did any of us imagine that we would see a rise in infant mortality in the sixth-richest country in the world. These figures are, quite frankly, inexcusable.

On social care, care homes in deprived communities often no longer receive enough to cover the costs of care, which inevitably compromises the quality that they are able to provide. For those in such communities who cannot afford private care homes, that reduction of quality, and in some cases the lack of any available residential care at all, has had a punishing effect.

All Members present will have received casework regarding those still in their homes in the community who rely on care packages. Their care is simply unacceptable, relying on care workers who are paid far too little and who often do upward of 25 care visits every single day. There is not a chance, even by unsustainably drawing on the boundless good will of those care workers, that visits could last for 30 minutes, as defined by official guidance. It is beyond the realms of possibility. Those millions of hours of lost contact time for the 470,000 vulnerable—predominantly elderly—people who use home care will have undoubtedly compromised their long-term care and support needs and the management of multiple conditions.

It perhaps should not be a surprise that the rise in mortality and the fall in life expectancy came from precisely that cohort—older women living alone in poorer areas. In many senses, they were the early-warning sign of the deeply troubling trend in increasing mortality. This cohort, more reliant than any other on a functioning, effective, compassionate state providing quality support, have been badly let down in recent years. It should be a source of national shame that elderly women in some of the most deprived areas of our country are living in isolation, not properly cared for, and are losing their lives because the state has not supported them. However, it is not just that cohort of women. Some 7% of the extra deaths in 2016-17 were of people aged between 20 and 60. Almost 2,000 more younger men and 1,000 more younger women have died than would have if progress had not stalled.

I am sure that the Minister cannot look at the evidence presented here today, or at the research undertaken over the past two years, and not want to take steps to tackle those shocking statistics and to prevent those lives from being cut short. It is therefore critical that Ministers and the Government take seriously the fall in life expectancy and the evidence behind the growth in mortality. Up to now, Public Health England has regrettably tried to attribute it to the greater prevalence of flu. However, as Loopstra noted in her report:

“If Public Health England’s attribution of rising mortality to cold weather and flu is correct, then it should lead to an elevation of mortality in regional swathes across the nation. However…trends have varied considerably across local authorities, with no apparent geographic patterning consistent with regional outbreaks.”

The rise in unexpected mortality and the concurrent fall in life expectancy represents a significant moment in the history of public health in this country, yet the Department of Health has so far rejected the call from public health professionals for an inquiry into the sharp rise in deaths. I repeat that call today, and ask the Minister to look very seriously at the evidence presented on the link between life expectancy and austerity.

I will end on the words of Danny Dorling and Stuart Gietel-Basten, who have undertaken so much of the research in this area:

“demography is not destiny. Projections are not predictions. There is no preordained inevitability that a million years of life need be lost…but only through politics comes the power to make the changes that are now so urgently needed.”

The Minister has that power in her hands, and there can be no more pressing question for her than to ask why the citizens of our country are dying sooner than they should. I hope she leaves no stone unturned in pursuit of that answer.

I do not intend to put a formal time limit on speeches. However, there are two Opposition spokespersons as well as the Minister, and I would like to start calling the Opposition spokespersons just after the hour, so if Members could speak for about five minutes each, that would be helpful.

I pay tribute to the hon. Member for Sheffield, Heeley (Louise Haigh) for bringing this important matter before the House.

I will start with the economics, because the debate relates to austerity and life expectancy. Government Members would probably talk about living within our means and would put to the hon. Lady the argument that the consequences for the poor and the vulnerable of a country continuing to live beyond its means are very grave. Economic history tells us that when countries lose control of their finances, it is not the well-to-do or the comfortable who suffer, but the poor and the vulnerable. That needs to be put very firmly on the record.

It is also worth noting that the Commonwealth Fund, which is an independent body, last year pointed out that our NHS was the best health system of the 11 different health systems it looked at. If we look at our outcomes on strokes, heart attacks and cancer, we see that they are getting better—there are 7,000 people alive today who would not be alive had we not seen that improvement in cancer outcomes.

Looking at the data across Europe, we see that what is happening in the UK is part of a trend, because life expectancy is also falling in Italy, Spain, France and Germany. Some of those countries spend quite a lot more on health than we do. France and Germany spend one percentage point of GDP more on health than we do, yet they have also seen that downward trend.

I will in a moment. There has been no austerity in Germany, because the Germans live within their means and run a big budget surplus. They have a trade surplus with China. However, life expectancy is falling in Germany as well. We need to look at these wider factors and at the European context. I will now of course give way, with great pleasure, to my former colleague on the Health Committee.

Does the hon. Gentleman also recognise from the data that there is not a similar fall in life expectancy in the Scandinavian countries and that it is wrong to look narrowly at health services, because the biggest driver in relation to life expectancy is poverty?

I will come on to those very important public health issues and what we need to do about them, because I care passionately about them, as probably everyone in the Chamber does. As the hon. Lady is from Scotland, it is also worth looking at what is happening there, because Scotland offers free adult social care and spends a higher amount on healthcare per head than England, yet still has a lower life expectancy than England. We need to get those issues firmly—

If the hon. Gentleman will forgive me, I am going to make a bit of progress, because I am mindful of your admonition, Mr Paisley, not to take too long and I want all the Opposition Members to have their say as well.

What do we need to do about this situation? We have 25% more nurses coming into the system—that training has started—and 25% more doctors coming into the system. We will get the social care Green Paper in July; we cannot get it a second too soon. I for one, as a Conservative Member on the Government side of the House, put up my hand: I want to see increased spending on health and social care, probably through a hypothecated tax. I think that is necessary. If we want quality, we have to pay for it.

We also need to consider issues such as obesity, exercise, air quality and housing quality. If we look at the obesity epidemic in our country, we see that it is now the poor who are much more obese than other social groups, and we know what a massive impact obesity has on health through diabetes and so on. We have to do better there. Why are only 2% of journeys in London made by bicycle? In Amsterdam, it is 30%. The children there cycle, there is much less childhood obesity, and that feeds into better health outcomes and better life expectancy. I chaired the Health Committee’s Sub-Committee that looked into air quality. We need to do a lot better on air quality, and we need there to be good- quality housing.

I salute the intentions of the hon. Member for Sheffield, Heeley. She is right to bring this issue before the House. But I would tell her to think of the broader economics and to look at the European comparisons and those important drivers of public health as well.

I congratulate my hon. Friend the Member for Sheffield, Heeley (Louise Haigh) on securing the debate. The issue of stalling life expectancy, and indeed of falling life expectancy in some areas, is very serious. The hon. Member for South West Bedfordshire (Andrew Selous) talked about living within our means, but people in my constituency are dying early without their means.

We must reach out across the party political divide on this issue, because the constituencies affected are in poorer areas of the country, as has been mentioned, but they are not anomalies; many different parts of the country are affected. I will give an example. Life expectancy for females at age 65-plus has fallen over the past five years by 0.8 years in Stevenage and by 0.6 years in Cheltenham. Life expectancy for males at birth has fallen in my county of Denbighshire by 0.6 years and by 0.9 years in Bromsgrove. This issue affects a great many of our constituents, across the political divide and across the country. There must be the political will for us to understand the root causes of what has resulted in this debate.

Does my hon. Friend agree that what is responsible for this situation is not just the restraint in spending, but the way in which spending restraint and austerity have played out on the frontline? The issue is the withdrawal of mental health services for people living at home. It is the teaching assistants who have all but been removed. In particular, it is the impact on services that help people to stay at home and manage conditions and the cuts to frontline policing that have led to the evisceration of not just life chances, but life expectancy itself.

I agree. All those issues are part of the mix as to why we are seeing a decrease in life expectancy. It is a complex issue that needs further inquiry.

I am afraid that I must move on, because I have been getting eyes from the Chair and I do not want to upset Mr Paisley.

The Government have said that the situation is a blip because of flu or the cold weather. The Department of Health has seemed to downplay fears about life expectancy, pointing out that smoking rates have gone down and cancer rates have gone down, but that is all the more reason to be worried. If those indicators are going down and life expectancy is going down, what is causing that? Those are good indicators, but there are some bad outcomes for certain people in certain areas.

A report by Professor Martin McKee, whom I had the pleasure of meeting yesterday, notes that the most recent period

“has seen one of the greatest slowdowns in the rate of improvement”

in life expectancy

“for both sexes since the 1890s”.

The relative data on life expectancy today is comparable to a time before workers’ rights, advancements in medicine and technology, and the welfare state. That slowdown, as reported by the Office for National Statistics last July, shows that the increases in the previous period, before 2010, meant that for every five years that a woman was living, she could expect to live one year extra. Now it is the case that for every 10 years that a woman is living, she can expect to live one year extra. The rate has been halved.

Let me add to those figures some of my own, which I received through parliamentary questions that I tabled in January. Between 2009-11 and 2014-16, 19.8% and 20.3% of local authorities reported a decline for females at birth and at 65-plus respectively. There are certain areas of the country, certain demographics and certain genders—women—who are feeling this the most. That is no surprise, because 80% of the austerity cuts made since 2010 have fallen on the shoulders of women. The link between life expectancy and cuts to social care budgets has already been highlighted.

The hon. Member for South West Bedfordshire mentioned Scotland. I do not want to stick up for the Scots: they can do a good job themselves, especially the hon. Member for Central Ayrshire (Dr Whitford), with her medical background. However, there are national and regional variations within the United Kingdom. If we look at local authorities in England, we see that 22% of them have seen a decrease in life expectancy.

In Wales and Northern Ireland the figure is 18%. In Scotland it is only 6.2%. In the north-east of England, 27% of local authorities have seen a decrease in life expectancy. There are regional differences. What we can draw from that is that where there has been devolution and kinder, gentler Administrations, there has been a less sharp decline.

Hope is a powerful motivator in the way we make decisions. Messages of hope won historic victories for my party in 1945 and 1997 and denied the current Government their majority last year. What the Conservatives proposed at the last election, after seven years of austerity, was another 10 years of austerity. There is learned helplessness out there. People are sick and tired, and they are dying because there is no hope. They have lost income—£2,000 for most people and £5,000 for teachers. Austerity is biting, not just in medicine but in social care, and affecting mental health and physical health. In the short time I have left, Mr Paisley, it is worth noting—

There is very little time, so I will draw my comments to a close by saying that Professor Martin McKee and other academics, from Oxford and other universities, want the Health Committee to have an inquiry on this issue. It is complex. I have mentioned some of the causes, and other MPs, from both sides of the Chamber, have mentioned some of the other causes of the decline in life expectancy. It is a complex mix of issues and deserves an inquiry by the Health Committee.

It is a pleasure to serve under your chairmanship this afternoon, Mr Paisley. I shall keep my comments brief because many other Members wish to speak. I also take the opportunity to congratulate the hon. Member for Sheffield, Heeley (Louise Haigh) on securing a debate on this important matter.

When people think of the rolling hills of west Oxfordshire, I appreciate that poverty is not one of the things that immediately springs to mind, but that is to ignore some of the very real issues present in my constituency. There are real factors and pockets of deprivation, and rural poverty in particular is a real concern, so the issue is very live for those of us in the green shires, as well as for those in urban environments. I would like the House to bear that in mind.

The hon. Lady made some important points today, but I suggest that it is simplistic to look at a straightforward line between necessary control of public spending and an impact on life expectancy. As we have heard, a whole range of factors affect life expectancy and mortality—quality of life, mental health, obesity, housing, air quality—and simply to draw that straightforward causation line is to make things far too simple, when in fact we are dealing with a complex issue.

The hon. Gentleman talked about it being simplistic to talk about the cuts, austerity and so forth, but let us talk, for example, about the cost of a pupil going to a pupil referral unit being 10 times more expensive, or the cost of someone in prison being £35,000 per year. If we invested such money earlier in education, mental health support or support for our young people, we would save money. Indeed, he is the one coming out with the simplistic argument.

The hon. Lady will not be surprised to hear that I do not agree with her. She made a number of points, but I am simply suggesting that the issue is complex. Saying simply that necessary control of public spending leads to an increase in mortality, as is being suggested, is too simplistic.

Let us look at the example of Scotland—this is a simple and important point—where free adult social care is offered and more is spent on healthcare per head than in England. However, life expectancy there is still lower than in England. That simply underlines my point, which I make in response to the hon. Member for Sheffield, Heeley, that it is too simplistic to say that that link between spending and outcomes is as straightforward as she would make out. That cannot be the case, or the situation in Scotland would not be as it is.

For that matter, let us look at the outcomes across Europe. The Public Health England figures are quite striking, particularly in graph form. They show that not only do we have a slight dip in life expectancy figures over the course of the past year or so, but so too do Italy, Spain and, strikingly, France—a dip almost identical to what we have seen in the UK, despite the fact that I understand the French spend the highest amount in Europe on healthcare. We are clearly dealing with a much more complicated situation, and lifestyle factors are crucial. Those are not restricted to the UK.

I am glad that the hon. Member for Sheffield, Heeley has accepted that life expectancy cannot be expected to increase forever. That is of course common sense and a point that she readily accepts, but the point bears repeating and remembering. For a number of reasons we have had extraordinary success in increasing healthcare over the past few years, but we are now faced with the results of that—an ageing and increasing population, therefore with increased complexity of morbidity factors.

I therefore applaud the approach being taken by the Government. We are not only investing as much as possible within the constraints of sensible Government spending, but ensuring that we address the lifestyle factors that can affect life expectancy in the round. However, as I continue to speak, I can see you looking at me with concern, Mr Paisley, so I will confine myself to those remarks.

The hon. Member for Sheffield, Heeley (Louise Haigh), whom I commend for securing the debate, spoke a lot about the impact of austerity on health and social care. To pick up on that, I should say that austerity has a triple impact. Spending on health and social care ends up being strangled, as we have seen: the reduction of the annual climb in expenditure from 3.5% to approximately 1%.

Of the two other impacts, one is the economic impact that we have faced ever since the crash at the end of the 2000s and which has been felt throughout Europe—I have a German husband, and I can tell you that while Germany itself may have a surplus, there are people there who are struggling and have not seen the wage rises that they would have liked. Also, in this country especially, we have seen welfare cuts, which have removed social security from people, creating particular areas and populations of poverty. That has particularly hit the disabled, children and pensioners.

There has been a lot of talk about healthcare. After 33 years as a doctor, I have to say that we can have far too much faith in what medicine can do to change overall life expectancy. We have some impact, but the biggest driver of ill health and the biggest impact on life expectancy is poverty and deprivation. That is something we have seen increasing in this country.

For example, over the past 20 years the rate of pensioner poverty dropped 28% to 13% by 2011-12, but it has now come back up to 16%. Twenty years ago in England, child poverty started out at 33%, got down at best to 27% in 2011-12, and is now back up at 30%. In fact, Scotland has the lowest rate in the UK: we started at a similar level, got down to 21% in 2011-12, and are still the lowest, at 24%. However, we have seen the same uplift, and that is because of aspects of social security and the impact of things such as the removal of child tax credits or the cuts to all the various social security supports. Over the past few years, similarly, poverty in general has risen slightly in England, Wales and Scotland, although Scotland has the lowest poverty rate, at 19%.

Important impacts of poverty on health include housing and fuel. People in the lowest 20th will be spending a third of their income on housing and, in the north of Scotland, another third on fuel. People are literally being squeezed and are struggling to eat well, which of course impacts on their health. We can see big differences in wealth across the UK. There is approximately twice the wealth in Kensington and Chelsea as in Glasgow—as well as more than 10 years’ difference in life expectancy.

As has been mentioned, the improvement in life expectancy has halved, from three months to approximately six weeks, although in Scandinavian countries the improvement continues, because social support and the social fabric is something they invest in. In Scotland the life expectancy deprivation gap has narrowed from 13.5 years to nine. That gap can, in the raw sense, be influenced by healthcare—we manage to keep people alive—but we are not keeping people healthy. They are surviving but accruing more and more diseases. In Scotland, therefore, the healthy life expectancy gap has increased from 22.5 years to 26 years. People are struggling with all of that, and it results in a much higher health spend and much more pressure on the NHS. That is exactly what Members have been saying: there is no sensible saving of money if it ends up being spent somewhere else.

Infant mortality is a measure of the impact of poverty on health that is used right across the world. For three decades, infant mortality had been dropping; it has now taken a small uptick. In Scotland, again, we have the lowest infant mortality rate—0.5 per 1,000 live births lower than in England—but it too has gone back up. Look at the contrast between the wealthiest and poorest areas: in the wealthiest areas, just over 2.5 babies per 1,000 live births will die within a year; and in the poorest areas the rate is more than double that, at 5.9 per 1,000 live births. Read Professor Marmot, and we cannot escape what we have known for 20 years: that the biggest impact on survival, quality of life and outcomes is poverty—and the biggest driver of poverty is austerity.

It is a pleasure to serve under your chairmanship, Mr Paisley. I thank my hon. Friend the Member for Sheffield, Heeley (Louise Haigh) for securing this important debate and for her excellent and well-informed speech. It is of great interest—not only to me, but to the public, who I am sure will be listening closely to the Minister’s response today. I also want to thank the hon. Members for South West Bedfordshire (Andrew Selous) and for Witney (Robert Courts), my hon. Friend the Member for Vale of Clwyd (Chris Ruane) and the Scottish National party spokesperson, the hon. Member for Central Ayrshire (Dr Whitford), for their thoughtful and passionate speeches, even though I do not necessarily agree with all the things that were said.

As we heard, life expectancy has always gradually increased. Between 1920 and 2010, it increased from 55 to 78 years for men and from 59 to 82 years for women. However, the improvement began to stall in 2011 when the coalition Government came in. That cannot be just a coincidence. Since then, for the first time in over a century, the health of people in England and Wales has stopped improving, and has flat-lined ever since.

I must emphasise that researchers do not believe that we have reached peak life expectancy. The Nordic countries, Japan and Hong Kong all have life expectancies greater than ours and they continue to increase, so why is life expectancy flat-lining in the UK? Why is Britain being left behind and fast becoming the sick man of Europe? I know that the hon. Member for South West Bedfordshire said that that was not the case, but academic research by Danny Dorling, published in November 2017, which I have here, said:

“Life expectancy for women in the UK is now lower than in Austria, Belgium, Cyprus, Finland, France, Germany, Greece, Iceland, Ireland, Italy, Liechtenstein, Luxembourg, Malta, the Netherlands, Norway, Portugal, Slovenia, Spain, Sweden, and Switzerland. Often it is much lower. Men…do little better.”

I think the hon. Gentleman needs to check his facts.

The life expectancy gap between the richest and poorest in this country is nothing less than shameful. According to the Institute of Health Equity, the longest life expectancy in the country is, not surprisingly, in the richest borough: Kensington and Chelsea. Men in Kensington and Chelsea can expect to live to 83 and women to 86. Unsurprisingly, you will find the lowest life expectancy in my part of it: the north and Scotland. In Glasgow, life expectancy for men is 73 and in West Dunbartonshire it is 79 for women—10 years of difference for men and seven years for women. The difference within the richest borough, Kensington and Chelsea, is even more stark. Despite living in the richest borough in the country, the most disadvantaged within it can expect to live 14 years less than their most advantaged counterparts. Does the Minister agree that this is completely unacceptable?

The north-south divide remains as relevant as ever when we look at healthy life expectancy—the years that people can expect to live a healthy life. In the south-east, the healthy life expectancy is 65.9 years for men and 66.6 years for women. However, people can expect a shorter healthy life expectancy in the north-east, where men have a healthy life expectancy of 59.7 years and women 59.8 years. That is significantly lower than the England average. Looking after those people during that unhealthy part of life means a huge cost to the NHS. It also means that the inequality gap in healthy life expectancy at birth between the south-east and the north-east is 6.2 years for men and 6.8 years for women.

What will the Minister do to address the life expectancy and healthy life expectancy gap between the rich and poor, and the north and south? It is simply unacceptable that the least advantaged in our society bear the brunt of this Government’s policies—wherever they live. Austerity is not a choice. It is a political ideology, which harms the poorest and the most vulnerable in our communities.

It is not rubbish. Professor Sir Michael Marmot warned:

“If we don’t spend appropriately on social care, if we don’t spend appropriately on health care, the quality of life will get worse for older people and maybe the length of life, too”.

Sadly, we have seen this across the board. Despite the growing pressure on our health and social care service, the Government are responsible for spending cuts across our NHS, social care and public health services. While demand continues to increase, the Government have taken away vital funding, which could close the life expectancy gap.

Since local authorities became responsible for public health budgets in 2015, it is estimated by the King’s Fund that, on a like-for-like basis, public health spending will have fallen by 5.2%. That follows a £200 million in-year cut to public health spending in 2015-16. Further real-term cuts are to come, averaging between 3.9% each year between 2016-17 and 2020-21. On the ground, that means cuts to spending on tackling drug misuse among adults of more than £22 million compared with last year and smoking cessation services cut by almost £16 million. Spending to tackle obesity, which the hon. Member for South West Bedfordshire mentioned as a cause of shorter life expectancy, has also fallen by 18.5% between 2015-16 and 2016-17 and further cuts are in the pipeline. These are vital services for local communities and could benefit their health and lifestyle, but sadly they continue to be cut due to lack of funding.

How does the Minister expect to close the life expectancy gap without investing properly in vital public health services? An ounce of prevention is better than a pound of cure. The Government must invest in public health and prevention services, as that could play a significant role in closing the life expectancy gap that we are discussing.

When the Prime Minister made her first speech on the steps of Downing Street—the Minister is nodding, because she knows the quote—she said:

“if you are born poor, you will die on average nine years earlier than others.”

We were all pleased that the Prime Minister highlighted that issue, but I have been left disappointed with her Government’s lack of response to tackle it. We on this side of the House are committed to ensuring that our health and care system is properly funded, so that all children are given the best possible start in life and older people are treated with the respect and dignity that they deserve. I hope that the Minister will clearly outline what the Government will do to close the life expectancy gap.

Before I call the Minister, I thank all hon. Members for complying so obediently with the timing that I requested.

It is a pleasure to see you in the Chair, Mr Paisley. I thank all hon. Members who have contributed. Clearly, we all want the best possible outcomes for all our constituents, and it is in that spirit that we approach this debate. I congratulate the hon. Member for Sheffield, Heeley (Louise Haigh) on securing the debate. I know her constituency well. Actually, looking at hon. Members opposite, I know the constituency of the hon. Member for Lewisham, Deptford (Vicky Foxcroft) well, also. That really brings into stark relief some of the issues we are talking about, because at the heart of the issue of life expectancy is the issue of inequality. I can speak from personal experience in my own constituency. The hon. Member for Washington and Sunderland West (Mrs Hodgson) talked about the differences between north and south, and rich and poor. Within my constituency there is a 10-year difference in life expectancy in the two-mile trip from the north of my constituency to the south, where it is poorest.

We are all acutely aware that inequalities lead to lower life expectancy. It would be a poor Minister for Health—indeed, a poor Member of Parliament or anyone involved in public life—who did not think that was important. It is important that we address it and we are determined to do so. I will run through some things, which tell a better story than the stark figures we have heard today. I will also address some of the points made about those figures, because I think it would be premature to draw too many conclusions at this stage about the causes of those and whether this is a long-term trend.

My hon. Friend the Member for South West Bedfordshire (Andrew Selous) also made some wise points. Ultimately, we can only spend what we collect from taxpayers. We are having an active debate on the extent of the funding we need to make available for health and social care. In this 70th anniversary year of the founding of the NHS, it is appropriate to focus on that. We will continue, notwithstanding the fiscal challenges that we face, to prioritise spending on health.

It is important to emphasise that this dip in life expectancy is not unique to the UK. We have seen it elsewhere in Europe. We need to be circumspect about drawing too much by way of conclusion.

The hon. Member for Washington and Sunderland West mentioned the Prime Minister’s speech. I want to supply the context of the Government’s approach against the background of that speech. The Prime Minister made it a priority to fight injustice and inequality. Ultimately, we know that by focusing actions on the people, communities and localities with the greatest needs, we will achieve the best health outcomes. As the hon. Lady said, we will also reduce long-term demand on the NHS and social care services, so it is smart to focus our strategy on tackling inequality.

We need to be honest about facing up to what the sources of inequality are. Sometimes, those will make us uncomfortable. One of the most disadvantaged groups in our society is those with learning disabilities. They will live 20 years less than the rest of us. For me, that is a very uncomfortable truth to live with. Successive Governments have tried to direct resources to help that group of people, but it is still not working. That leads to the realisation that this is as much about behaviour and leadership as it is about money.

Putting that aside for one moment, could the Minister explain to Members of the House why infant mortality rose for the first time in 30 years in 2016 and 2017? If it is not linked to the issues that my hon. Friend the Member for Sheffield, Heeley (Louise Haigh) mentioned, what is it linked to?

The right hon. Gentleman knows that we have made tackling that a priority. It is too early to draw any conclusions. It is the case that poverty is a big source of inequality, but we need to do more work before drawing conclusions. Having developed the evidence, we will act. There is a reason that we have developed a national maternity safety strategy. There is a reason we are focusing resource on the perinatal phase, because we recognise it is critical. We will also continue to spend money on the healthy living supplements to give children a better start in life and to tackle some of those inequalities.

The Minister accepts in her speech that poverty is a big driver of these changes and talks about doing more, but we expect that over the next few years another quarter of a million children will be driven into child poverty. It is not a matter of doing more. In fact, the policies at the moment are making the situation worse.

I do not accept that. The real issue for us as a Government is being able to make those interventions that address the sources of inequality. It is about giving practical steps, which I will come to in more detail.

The hon. Member for Sheffield, Heeley referred to the article in The BMJ by Hiam and Dorling about the spike in mortality and winter deaths. She was absolutely right to highlight that. We must pay attention to emerging studies. However, using the total number of deaths can be misleading and needs to be put in the broader context. It does not take account of the ageing population and the fluctuations in population numbers. We use the age-standardised mortality rate as the accepted measure, which looks broadly stable. Clearly this is not something we should be complacent about, and we should continue to keep a very close eye on trends in those numbers.

I mentioned people with learning disabilities living for 20 years less than the rest of us. It is good that that figure has come down since 2000. Their life expectancy has risen by seven years since the millennium. We must encourage that direction of travel by supporting them to live full, healthy and independent lives. That goes to show that having better health is not just an issue for the NHS and health services, but is about having more support to get people into work and to help them to live in the community. We need to use every interface with the state to achieve that.

If we take a lifestyle approach to securing the best possible health outcomes and tackling inequalities, an individual’s start in life is the beginning of that. We are focusing on pregnancy through early years and into old age to ensure that every child gets the best start and journey through the rest of their life. Public Health England is leading programmes to ensure that women are fit during pregnancy. It is leading programmes to ensure that children are ready to learn at two and ready for school at five. We want to continue to support smoke-free pregnancy, which leads to better health for children. Central to that is local commissioning driving best-quality service and interventions as appropriate.

We are obviously very concerned about childhood obesity. If we do not tackle it, it will set people up for poor life expectancy in the longer term. It is worrying to see the number of children entering school at the age of five who are already obese. We need to leave no stone unturned to achieve early intervention. Broader public education about the impact of sugar is helping, but there is much more we can do to encourage people to adopt healthier lifestyles.

Could the Minister confirm what the net change in investment in early intervention has been since the Conservatives came to power?

I cannot give the hon. Lady that information now, but I will write to her.

Alcohol is a source of poor health outcomes, so we are also doing much to tackle that. I am in dialogue with Members on both sides of the House about supporting the children of alcoholic parents, recognising that they are a particular need group. I thank those hon. Members who have been associated with that.

With Scotland having been the first place to ban smoking in public places, and now moving forward with minimum unit pricing for alcohol, will this Government consider following that lead for England to tackle alcohol?

I am grateful for that point, which consideration is being given to in the Department. There are any number of tools that we could use to tackle alcohol. Probably the most important thing is to give the message that unsafe drinking is bad for the health. It is always interesting to learn from Scotland’s experience, and we will keep an eye on that.

Tobacco is a major cause of poor health. It is worth noting how much progress we have made over decades to reduce the prevalence of smoking. That should lead to better health outcomes, but that has yet to be seen.

Rates of premature deaths in Hartlepool and the north-east are among the highest in the country. Other issues such as poor-quality housing, food poverty, fuel poverty and unemployment are also factors. Does the Minister agree that those factors also need to be taken into consideration?

I agree. That is exactly the point made by the hon. Member for Central Ayrshire (Dr Whitford). Housing is probably the single most important ingredient in good health. We often talk in this place about there being a housing crisis and about the need to fix the broken housing market and get more supply. Amen. The fact that we have failed to manage the supply of housing effectively for decades is bringing bigger health challenges. We really need to crack that if we are to tackle some of these issues.

I could go on, but we are running short of time. We are seeing very good rates of improvement in health for things such as cancer, and much better outcomes for people. The direction of travel means that there are good things to report. I am grateful to all hon. Members who have approached this debate with real thought about the very serious issue of the decline in life expectancy. I am sure that we will revisit the issue, but my lasting message is that we see the method of tackling this being tackling inequalities. That is what I pledge to do.

Question put and agreed to.


That this House has considered austerity and changes in life expectancy.

Sitting adjourned.