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Health Inequalities

Volume 672: debated on Wednesday 4 March 2020

I beg to move,

That this House notes the publication of Health Equity in England: The Marmot Review 10 Years On; is concerned by its findings that since 2010 improvements to life expectancy have stalled for the first time in more than 100 years and declined for the poorest women in society, that the health gap between wealthy and deprived areas has grown, and that the amount of time people spend in poor health has increased across England; agrees with the review that these avoidable health inequalities have been exacerbated by cuts to public spending and can be reduced with the right policies; and calls on the Government to end austerity, invest in public health, implement the recommendations of the review, publish public health allocations for this April as a matter of urgency, and bring forward a world-leading health inequalities strategy to take action on the social determinants of health.

A former Health Secretary, Frank Dobson, whom we sadly lost towards the end of last year, said:

“Inequality in health is the worst inequality of all. There is no more serious inequality than knowing that you’ll die sooner because you’re badly off.”

He was absolutely right. Poverty and deprivation mean that people become ill quicker and die sooner. The current Health Secretary—I understand why he cannot be here for this debate; I do not criticise him for that, given what is going on, and we welcome the Under-Secretary of State, the hon. Member for Bury St Edmunds (Jo Churchill), to the Chamber—said, when we last debated health inequalities, that

“extending healthy life expectancies is a central goal of the Government, and we will move heaven and earth to make it happen.”—[Official Report, 14 May 2019; Vol. 660, c. 153.]

Well, last week the respected academic, Sir Michael Marmot, gave us his assessment of the Government’s attempts to move heaven and earth to narrow those inequalities and extend healthy life expectancy.

I absolutely congratulate my hon. Friend on bringing this crucial issue to the Chamber. The health inequalities that we have seen in our communities are bad enough, and the additional inequalities regarding access to GP appointments are even worse, but we are also seeing cuts in local government funding hitting the most deprived areas and adding to those inequalities we are already aware of.

My hon. Friend makes that point very well. Not only are there inequalities in health outcomes, but inequalities are opening up in access to health services.

I said that I understood why the Secretary of State cannot be here, but he has now joined his colleagues on the Front Bench. I will state, just for the record so that he can be reassured, that I did not criticise him for not being here—I said that I entirely understood why he could not be here. But he is always welcome to listen to my pearls of wisdom, of course.

Michael Marmot’s analysis was shocking, and his conclusions devastating. Let me remind the House of what Professor Marmot found: for the first time in more than 100 years, life expectancy has essentially flattened overall since 2010, and has actually declined for women in the poorest areas of England. In last week’s Opposition day debate, the Health Secretary told Opposition Members that we must debate these issues based on the facts. In fairness, he said that there were life expectancy differences between, for example, Blackpool and Buckingham. [Interruption.] Indeed—gulfs. The Secretary of State made that point. If I may say so, however, I do not believe that he was as clear as he could have been in presenting the full picture for the benefit of Members. When we look at the figures, we see that for more than 100 years, life expectancy has been increasing by about one year every four years. More recently, from 2001 to 2010, the increase was 0.3 years for each calendar year for men and 0.23 years for women. Between 2011 and 2018, the average rate of increase was 0.07 years for males and 0.04 years for women. By any standards, that is a truly dramatic lowering in the rate of improvement in life expectancy between 2011 and 2018.

The latest figures for my city of Sheffield show that life expectancy is nearly nine years more for women from the least deprived decile than the most deprived, and that gap has widened significantly since 2010. Does my hon. Friend agree that, as we approach International Women’s Day and the Budget, we must be mindful of the toll that austerity has taken on our cities and across the country, especially in relation to life expectancy and quality of life?

I welcome my hon. Friend to her place. She is already an eloquent and passionate fighter for her constituents in Sheffield, and the point she makes is spot on: the reality is that 10 years of austerity has hit women hardest.

I will give way to my hon. Friend, but then I must make some progress because, as I understand it, some Members want to make maiden speeches in the debate.

I thank my hon. Friend for giving way. Health inequalities between regions are stark, but there are also huge disparities across short distances. In my constituency, the life expectancy of men in St Michael’s is 13 years shorter than it is of men just 2.5 miles away in Stoneleigh, just south of Coventry. Does he agree that to reduce those shocking health differences, the Government need to tackle underlying economic inequality and systemic poverty, and reverse 10 years of Tory cuts?

Order. The hon. Lady’s intervention might not have seemed very long to her, and I appreciate that she is new to the House, but it was very long. I thank the hon. Member for Leicester South (Jonathan Ashworth) for what he said before he took that intervention. It would be much appreciated if the Front-Bench spokespeople took only a few interventions. This is a debate—we can have some interventions—but if Members who intend to intervene and then leave take up all the time at the beginning of the debate, those who sit here all afternoon will not get to speak at the end. We are talking about unfairness here, and that is unfair. The hon. Gentleman has been most courteous, and I know that the Minister has also been courteous in saying that she intends to take only a few interventions.

I am grateful, Madam Deputy Speaker, but the point made by my hon. Friend the Member for Coventry South (Zarah Sultana) was an excellent one. She is right: this variance in life expectancy and these widening health inequalities are surely intolerable, and we have been sent here by our constituents to do something about it.

Taking your guidance, Madam Deputy Speaker, I will try not to take any further interventions, because I am aware that Members want to make maiden speeches. I am sure that Members who have been in the House a bit longer will testify that I am usually very generous in taking interventions. I hope Members will understand.

I dare say that the Minister will pray in aid the Office for National Statistics data that came out last night, but that is just a single data point. The ONS data also shows that regional inequalities in health have widened since 2010 and confirms that life expectancy for women in the most deprived decile outside London and the north-west has fallen. The rate of increase in life expectancy slowed markedly after 2010, which just happens to coincide with the swingeing cuts to public services and working-age benefits that the Tory Government imposed upon our society.

When life expectancy stops improving, inequalities widen and health deteriorates. That is why Sir Michael Marmot found that time spent in poor health is increasing for men and women in the most deprived areas of England. He found that there is a north-south gap opening up, with some of the largest decreases seen in the most deprived 10% of neighbourhoods in the north-east. He found that the mortality rate among those aged 45 to 49 is increasing. So-called deaths of despair—the combined effect of increasing death rates from suicide, drug abuse and alcohol-related illness—are a phenomenon we have seen for many years in the United States, and they are now making their morbid presence felt here. Perhaps most shamefully of all, the most deprived 10% of children are now twice as likely to die as the most advantaged 10% of children, with children in more deprived areas more likely to face a serious illness during childhood and to have a long-term disability. Surely this stands as a devastating and shameful verdict on 10 years of Tory austerity and cuts. Of course, we have always had health inequalities since the NHS was created 70-odd years ago, but the point is that the Government should be trying to narrow them, not widen them, because as Professor Marmot says,

“if health has stopped improving it is a sign that society has stopped improving.”

Perhaps some will quibble with Marmot’s findings, but they coincide with what others have found. For example, the all-party group on longevity found a few weeks ago that men and women in our poorest areas are diagnosed with significant long-term conditions when they are, on average, only 49 and 47 years old respectively. The Institute for Fiscal Studies’ Deaton review has also warned about deaths of despair, pointing out that rates of long-standing illness and disability among people aged 25 to 54 have been increasing since 2013. The Royal College of Paediatrics and Child Health has today warned of stalling infant mortality rates and how a generation of children is being failed.

I am afraid that this does not suggest that the Government are “moving heaven and earth”, in the words of the Secretary of State, to tackle widening health inequalities, and it does not fill us with much confidence that the Secretary of State is on target to meet his goal of five years’ longer healthy life expectancy by 2035. Will the Minister update us on how we are getting on in meeting that target?

I hope that the Minister, who has responsibility for public health, will also give us some reassurance about the Government’s plans to mitigate the health inequality implications of the covid-19 outbreak. May I press her to explain exactly what the Prime Minister meant at Question Time earlier? Is the Prime Minister saying that statutory sick pay will kick in from day one? If so, we welcome that, but because of low pay, the earnings threshold, precarious work, the gig economy and zero-hours contracts, about 2 million people are not eligible for statuary sick pay. The Prime Minister seemed to suggest at Question Time that such people would be eligible for universal credit, but the Government’s own guidance—I checked the website just before the debate—makes the position crystal clear. The Government’s website says:

“It usually takes around 5 weeks to get your first payment”

in respect of universal credit. The public health implications of that should be blindingly obvious: some of the lowest-paid workers who need to self-isolate will be forced to make a choice between their health and financial hardship. Surely it would be far simpler and smoother just to guarantee statutory sick pay for everyone from day one.

There are also practical problems with sick notes. People are being asked to self-isolate for a fortnight, but as the Secretary of State himself said yesterday, self-certification lasts for only seven days. Will this now be extended from one week to two weeks? I put it to the Minister, as I put it to the Secretary of State yesterday, that we will co-operate and help the Government with emergency legislation to ensure that statutory sick pay for all from day one is on the statue book as quickly as possible. Will Ministers take up our offer?

I dare say that the Minister will want to remind us of the funding settlement for the NHS for the next four years, but she will not be able to remind us of the public health funding settlement for local authorities for the next month because Ministers have not told local authorities what their public health allocations are for the next financial year, which starts next month. It is not good enough to say that the grant overall will increase. These are services that prevent ill health and promote health and wellbeing, as she knows, and those services have been left teetering after years of real-terms cuts of about £1 billion. Smoking cessation services have been cut, obesity services have been cut and drug and alcohol services have been cut, while health visitor numbers are falling, school nurse numbers are falling and mandated health visits are abandoned, yet directors of public health are expected to plan for the next 12 months when they have not even been given their local public health allocations. When will they be published? We are expecting directors of public health to put in place plans to deal with the covid-19 outbreak, and they do not even know their budget lines. That is clearly irresponsible and unsustainable.

It is not just about health funding, however, because that does not tell the full story, as the Secretary of State, in fairness to him, has recognised. He has said before that

“only around a quarter of what leads to longer, healthier lives is…what happens in hospitals.”

We need the Government to focus on the wider social determinants of ill health, too: the childhood experiences we are all exposed to; the neighbourhoods we grow up in; the schools we are nurtured in; the conditions of the work that we do, especially in today’s gig economy; the food we eat; the quality of air we breathe; and the support we rely on in our older years.

Whether it is air pollution, the toxic stress of precarious work or how the benefits system operates, it is those in poverty whose health suffers as a result. Just last week, a longitudinal study in The Lancet found that universal credit is exacerbating mental health issues among claimants, causing tens of thousands to experience depression and mental distress. The Government cannot deny the links between poverty and ill health, because poverty, as Sir Michael Marmot says, “has a grip” on our nation. Some 14 million adults live below the poverty line. We have record food bank usage. More than 4,000 of our fellow citizens sleep rough on our streets, a huge increase since 2010, and over 700 die on our streets.

The poverty a child experiences harms their health at that time and through the rest of their life. Child poverty impairs cognitive development and creates an environment in which mental health and emotional disorders fester. Children in poverty are more likely to be obese, less likely to be up to date with immunisations, and more likely to be admitted to hospital, yet under this Government, the number of children living in poverty has already risen to 4 million, and we have reports of children scavenging in bins. We have 120,000 children pushed from pillar to post in temporary accommodation—a huge increase under the Tories. The working-age benefit cuts that are set to come in will push child poverty levels to the highest since records began in 1961—higher than even in the Thatcher years. That is not levelling up; that is condemning future generations to ill health and shorter lives.

But poverty need not be inevitable and life expectancy does not have to stall. This House should not let health inequality leave an indelible stain on our society. There is a better way, and I commend our motion to the House.

Order. Before I call the Minister to move the Government amendment, I should tell the House that we will start with a time limit on Back-Bench speeches of seven minutes, but that will very soon reduce to around five minutes, as there is a very large number of people who wish to speak. I am trying to keep the time limit a little more flexible for those who are making their maiden speeches.

I beg to move an amendment, leave out from “10 Years On” to end and insert:

“notes that Government is committed to level up outcomes to reduce the health gap between wealthy and deprived areas, and supports the Government’s commitment to delivering long-term improvements for everyone no matter who they are, where they live or their social circumstances.”

First, I would like to say that I really welcome this debate on health inequalities, which will help us all to discuss the challenges that we face. Every single one of us, no matter who we are, where we live, or our social circumstances, deserves to live a long and healthy life. Our determination to level up and reduce inequalities by improving the health of the poorest fastest is clear. The recent 10-year anniversary report produced by Professor Marmot comprehensively highlights the important issues, and I thank him for his tireless work in this space, because much of what he drew in the 2010 report is similar to now: these are really complex issues that are very hard to tackle.

The Minister will be aware that 64,000 people die prematurely from air quality problems, at a cost of £20 billion, and she is probably aware that those deaths tend to be concentrated among poorer areas and poorer families, so does she agree that we should take decisive action on such things as the electrification of cars and diesel duty so that we reduce overall deaths and thereby have a go at reducing health inequalities as well?

The hon. Gentleman makes a good point, but it typifies the problems we deal with, because air pollution is the responsibility of the Department for Environment, Food and Rural Affairs, the Department for Transport and the Department of Health and Social Care. They all have a role to play, and we must ensure we take account of that—it is important that we think about all these different challenges. Helping people to live longer healthier lives while narrowing the gap between the richest and the poorest needs action, a point made by the hon. Member for Coventry South (Zarah Sultana).

If the hon. Gentleman will just bear with me and let me make a little more progress, I will come back to him.

Going forward, I am clear that we must integrate good health into decisions on housing, transport, education, welfare and the economy, because we know that preventing ill health, both physical and mental, is about more than just access to our health services.

In his opening remarks, the Opposition spokesman mentioned smoking cessation just once, yet we know that over half the excess mortality between social classes is directly attributable to smoking. Does the Minister agree that we will not make progress on this important subject unless we get real about this vile poison that has, unfortunately, picked off the poorest for decades and decades? It must stop.

The Minister is right that this is a very complicated issue and that health inequalities have existed for a considerable amount of time. On the research she refers to, will she tell us whether local government cuts, which have been greater in the poorest areas, with a significant reduction in health education and prevention work, were mentioned as factors for why this continues to be such a major problem?

The problems we are dealing with are complex across the piece, which is why we have held the public health budget at the same level this year so that we can start to deliver on them. It is important that local people have local ownership over the issues and challenges in their area, because one size will not fit all.

If the hon. Gentleman will bear with me for just a few minutes, I want to push on rather than incur the wrath of Madam Deputy Speaker.

I am clear that there must be integration across Departments, because dealing with these issues is about having a warm home that is suitable for you and those you love, and about having an environment that sustains your health. It is about good education, so that people are equipped with the skills to look after their health. It is about having jobs that are purposeful and rewarding.

The health inequalities challenge is stubborn, persistent and difficult to change, and I recognise the enthusiasm, energy and frustration that those who will speak in this debate will bring. The Government have firmly signalled their intention to take bold action on these issues. We are committed to reducing inequalities and levelling up. To be effective in reducing health inequalities, we need a long-term sustainable approach across all Departments. Early onset diseases, disability and avoidable mortality are concentrated in poor areas, so this is where we must act if we are going to make the system fairer.

I ask the hon. Lady to bear with me for just a minute.

It is important that we improve those with the worst-affected health the fastest. It is unacceptable that a man born in Blackpool today can expect 53 years of healthy life, while a man born in Buckinghamshire gets 68 years. We know that there is also inter-area variation, which is unacceptable. We have an opportunity to seize the initiative to do this across the country. The ageing grand challenge is to ensure that everybody can enjoy a further five years of healthy life by 2035, while narrowing the gap between rich and poor.

We set out our intentions in the prevention Green Paper published last year. The public consultation closed in October, following significant engagement. We had some 1,600 responses, which is more than double the average the Department usually receives from such public consultations. We are analysing the responses and developing our reply, which we will publish shortly. We want to shift the focus from treating illnesses to preventing illnesses and driving healthy lives. The NHS long-term plan contains commitments that outline the role the NHS can play in supporting that shift.

We are passionate, and I am passionate, about our commitment to an NHS that is fit for the future. That is why we are funding it with an extra £33.9 billion.

I commend the Minister for many of the points she is making. I want to clarify the point about interdepartmental work. We know from seminal works such as “The Spirit Level” that when we reduce the gaps between rich and poor, focusing not just on income but on wealth and power inequalities, we get increases in life expectancy across the community, as well as in social mobility, educational attainment and so on. If the Government recognise that, will they commit to considering what impact policies will have on health inequalities as they are being developed?

The hon. Lady will appreciate that I cannot speak for all Departments, but it is my job to drive home the value of health in those Departments and to ensure that, as she says, we think about the broader consequences across the policy-making piece.

In answer to my right hon. Friend the Member for South West Wiltshire (Dr Murrison), smoking does remain one of the most significant public health challenges. It affects disadvantaged groups in particular and exacerbates inequalities. That is particularly apparent when looking at smoking rates in pregnancy. Three weeks ago, I visited Tameside Hospital in Greater Manchester to see its smoking cessation work. It started with a much higher than average smoking rate, and having a tailored public health budget in the locality has allowed it drive down into the inequality within the community. It has a specialist smoking cessation midwife to help these young women, their families and their partners give up smoking—for their own health, yes, but also for the health of their babies.

I packed in smoking 15 years ago. I cannot understand why the NHS does not use people like me to go out there and help other people pack it in.

I thank the hon. Member—he has just got himself a job as an ambassador. I congratulate him on quitting smoking, because it is hard.

The specialist centre showed me that with the right holistic support and encouragement, the health of both mum and baby can be improved. Such services will be crucial in achieving the ambition of becoming a smoke-free society by 2030.

Similarly, we must tackle the health harms caused by alcohol, and support those who are most vulnerable and at risk from alcohol misuse. Through the NHS plan, up to 50 hospitals with the highest rates of alcohol dependency-related admissions will have alcohol care teams. That could prevent more than 50,000 admissions every five years. Currently, eight of those teams are in operation, providing seven-day services focused on those areas with the highest levels of admissions related to alcohol dependency.

Alcohol addiction has a devastating impact on individuals and their families, and it is unfair that children bear the brunt of their children’s condition. I know that this topic is dear to the heart of the hon. Member for Leicester South (Jonathan Ashworth), who has spoken about it movingly. I pay tribute to the way he has influenced this agenda in this place. I am pleased so say that we are investing another £6 million over three years to help fund support for this vulnerable group.

As is often the case with addiction, there is a toxic mixture of several items. On substance misuse, last Thursday I attended the UK-wide drug summit in Glasgow, along with Home Office Ministers and Ministers from the devolved Administrations. We discussed the challenges associated with drug misuse and listened to Dame Carol Black present her findings from the first phase of her review. I am pleased that my Department will fund and commission the second phase of the review, which will make policy recommendations on treatment, prevention and recovery. Only through the combined efforts of different Departments working together can we hope holistically to improve the health and other outcomes of people with substance misuse problems. Many of us know from our constituency work that they often bounce between various parts of the system. Local authority leadership and action on public health prevention is vital as it will help to focus local measures to decrease health inequalities. As a condition of receiving long term plan funding, every local area across England must set out specific and measurable goals, and ways by which they will narrow health inequalities over the next five and 10 years. Local areas know their localities best.

I thank the Minister for her kind words about me a few moments ago. It is an issue dear to my heart and, as she knows, I have run three London marathons to raise funds for alcohol charities—although that is not how I am proposing to fund services in the future.

The Minister has to recognise that whether it is smoking cessation services—I am sure the right hon. Member for South West Wiltshire (Dr Murrison) was not implying that I do not think that smoking cessation is important—or drug and alcohol services, they have suffered from a number of cuts. Directors of public health are desperate to know what their funding grant will be for the next financial year, starting in four weeks’ time. Can she tell us when they will know what their allocations will be, so they can fund all the work that she is talking about?

I appreciate that they need to know those figures, and they will know them extremely shortly.

I strongly believe that high-quality primary care is also crucial to early and preventive treatment, and key to reducing the health inequalities we are discussing. We are improving access to primary care by creating an extra 50 million appointments in general practice within the next five years, growing the workforce by 6,000 more doctors and 26,000 more wider primary care professionals. Within that, we want to target NHS resources, so that they can help their localities to level up. Through the targeted enhanced recruitment scheme, we are recruiting trainees to work in the areas of the country where we have had vacancies for years, particularly rural and coastal areas, such as Plymouth, and the coastal area of County Durham and North Yorkshire. It has already proved highly successful, with a fill rate of close to 100% last year, and over-subscription in many parts of the country. For that reason, we will increase the places on the TERS from 276 to 500 in 2021, and then up to 800 in 2020, to make sure that we get the skilled staff in the areas where they can do most good.

Practices, working together within primary care networks, will be asked to take action on health inequalities, to be agreed as part of the next 2021-22 GP contract. What happens in one’s early years, even before one pops out into the world, has an impact well into later life. Pregnancy and early years are therefore a key time to have an impact on inequalities. In particular, the fact that women’s life expectancy is so challenged is of acute importance to me. We have many challenges as we travel through life, and making sure that we are equipped to make the best of our lives, particularly as we often act as primary carers, is hugely important.

Pregnancy and early years are a key time to have an impact on inequalities. Many babies do get a fantastic start, but sadly it is not the case for everyone. Children in more deprived areas are more likely to be exposed to avoidable risks and have poorer outcomes by the time they start school. It is right that all universal support has a focus on reducing inequalities, and that it is targeting investment to meet higher needs. Many children are benefiting from investment in childcare and early years education. Fifteen hours of free early years education for disadvantaged two-year-olds and 15 hours of free early years education for all three and four-year-olds is key. We have also announced our commitment to modernise the healthy child programme to reflect the latest evidence to support families.

No, I am going to push on. I would particularly like to give those people making their maiden speech, which is hugely important, the time to do so.

For a good start in life, we need to do better in oral health. Tooth decay is the most common oral disease among children, affecting one in four by the time they start school, and it is the most common reason for admission to hospital for children aged five to nine. It is largely preventable. Improving the oral health of children is a Public Health England priority, and a number of actions are under way. Supervised tooth-brushing and water fluoridation are two evidence-based areas in which we want to go further. When I met a number of dentists recently and asked them what they would do if they had the key that would enable them to do anything, they said that water fluoridation would be one of the key measures to reduce childhood inequality across the country. In 2016-17, one in six children had tooth decay in the south-east compared with one in three in the north, and the variation is even greater among local authorities. I am delighted that two authorities, Durham and Northumberland County Councils, recently announced formal proposals to increase water fluoridation, and I hope to be able to facilitate that.

Obesity is a challenge. It is shocking that children in poorer parts of the country are more than twice as likely to be overweight or obese. Children who are overweight or obese are increasingly developing type 2 diabetes and liver problems, they are more likely to experience bullying, low esteem and a lower quality of life, and they are highly likely to become overweight adults with a higher risk of cancer and heart and liver disease. This is a huge cost to the health and wellbeing of the individual, but also to the NHS and the wider economy.

National cardiovascular disease and diabetes prevention programmes have already been introduced, but we want to go further. NHS England has delivered a diabetes treatment and care programme aimed at reducing variation and improving outcomes for people living with diabetes, thus reducing inequalities. We published the third chapter of the childhood obesity plan in July 2019, with further measures to help to meet our ambition to halve childhood obesity by 2030 and reduce the gap between the most and the least deprived. We have seen some important successes. The average sugar content of drinks subject to the soft drinks industry levy decreased by 28.8% between 2015 and 2018. Significant investment has been made in schools to promote physical activity and healthy eating. The childhood obesity trailblazer programme works with local authorities to address the issue at local level, and that really helps, with authorities working together to ensure that the messages sent to children are healthy food messages. The programme has a strong focus on inequalities and ethnic disparities in the context of childhood obesity, and is helping five local authorities to take innovative action. We have a lot to gain, particularly if we help parents, especially in the most deprived areas, to help their children.

It is clear that there is a great deal to do. Let me reiterate that the Government have made real commitments to real action, and that we will increase our focus on the real challenges that people experience in their lives every day. Reducing health inequalities is not an issue that truly divides the House, and I look forward to hearing the suggestions of Members on both sides of the House so that we can move forward. Their contributions will help to fuel our purpose. We share the common goal of reducing inequalities, and we can work together to achieve it.

Obviously I welcome what the Minister has said, but she talked about starting to take action and, given that we have had Conservative-led Governments for the last decade, I find it a bit surprising to hear talk of starting to take action now.

Health is much wider than the NHS. This is a confusion that many people make. Health is about everything else. In his acclaimed review “Fair Society, Healthy Lives”, Michael Marmot defined the social determinants of health: the conditions in which people are born, grow, live, work and age. He explained that the variation was driven by inequity in power, money and resource. The review set out how public expenditure could act on the social determinants to reduce health inequalities. The problem is that, although it was welcomed by the coalition Government—there was even a public health White Paper—no action was really taken. In contrast, in 2016, we saw essentially the repeal of the Child Poverty Act 2010, including the reduction targets to get more children out of poverty. In the 2020 Marmot review, therefore, we see not success over the past 10 years, but things going in the wrong direction.

I agree with the hon. Member about the social determinants of health. Does she agree that, going back 10 or 15 years, to before 2010, the Labour Government appreciated those determinants and directed public policy to that end?

I do. I respect the work that Labour did, and child poverty was falling. Interestingly, the upturn in child poverty we have seen did not happen with the crash in 2008; it happened after the 2012 welfare changes. That is striking. The impact of Government policy has been austerity in every way and in every approach to individuals, families and communities. We have seen slow income growth for the vast majority of people over the last decade. There has been absolute inequality. The majority of the growth that there has been, has been at the top. The national living wage simply is not a living wage. More people are in insecure work—zero-hours contracts, the gig economy—and do not have protections. As the shadow Health Secretary mentioned, in all the discussion about covid-19, we have been trying to highlight that people on low pay and insecure contracts do not get sick pay, yet we will be asking them to stay at home for two weeks and self-isolate. In the meantime, the wealthiest people have actually trebled their wealth. So categorically we have not all been in it together over the last 10 years.

In addition, we have seen a restriction on public expenditure. The regressive welfare cuts of 2012 and 2016 have reduced support for families by 40%: the benefit cap, the benefits freeze, the two-child limit, the five-week wait for universal credit, which puts people in rent arrears and debt, personal independence payments, the bedroom tax. Eighty per cent. or more of these cuts have affected women directly because they tend to be lower paid, to be carers and to rely more on services. In the main, they are responsible for children. The disabled have also been particularly hard hit. We have not seen a cumulative impact assessment of female lone parents who are disabled and have three or more children. Some of them have had their income slashed.

There have been cuts to local government and services. Interestingly, the least deprived areas face 16% of cuts, while the most deprived on average had 31% cut from their local government budget. I have heard Labour Members talk about between 40% and 60% cuts in their local government budgets. There are changes in the pipeline to move £300 million from local authorities in the north to the south. I wonder if that will be reversed now that the Conservative party has won some seats in the north.

Some years ago, when I was a councillor, I had a harrowing case involving a young female constituent who was clobbered by the bedroom tax. She has multiple sclerosis and she was going to lose a lot of cash. I want to put on the record my thanks to the Scottish Government for the action they took to ameliorate and offset that tax.

I thank the hon. Member for that recognition. The Scottish Government are spending more than £100 million every year in mitigating some of these cuts—they pay the bedroom tax and they have set up the Scottish welfare crisis fund—but that is money that should be going into devolved areas, not patching up austerity decisions here; it is not the role of the Scottish Parliament just to mitigate.

Public health in England has been cut by £850 million—again, the greatest cuts to the poorest areas—and it is exactly the same with future planned cuts. This has led to cuts in smoking cessation projects. There is no point standing up and talking about the importance of stopping smoking—we all know that. People who have smoked for decades need help to stop and those services are critical. We have also seen cuts to drugs and alcohol projects and to sexual health projects, and all those have an impact on the poorest people.

The Minister, who is no longer in her place, might have listened to Dame Carol at the drugs summit in Glasgow but, sadly, the Minister for Crime and Policing, the hon. Member for North West Hampshire (Kit Malthouse), did not. He came to Glasgow, made his speech and then left before all the expert evidence was given. We also hear of a social care gap across England of over £6 billion. Again, that affects women if they have to give up work to look after elderly relatives or disabled children. This rolling back of the state has affected the social determinants and increased health inequalities. Child poverty has increased, as we have heard, with 4 million children affected, and 1,000 Sure Start centres have been closed. Education funding is down. There is a housing crisis and therefore a rise in homelessness. People with insufficient funds to afford a healthy life are depending on food banks, and deprived communities are simply losing hope.

Poverty is simply the biggest driver of ill health and has the biggest individual impact on life expectancy. The increase in life expectancy in England has stalled for the first time in 120 years—the first time since 1900. The gap between the most and least deprived has widened: the gap is now almost 10 years for women and the life expectancy of some women in areas of the north-east of England has dropped by almost a year.

I always listen with great respect to what the hon. Member has to say, but given that the SNP has its hands on many of the levers relating to the things she has discussed this afternoon, I am assuming from what she has said that Scotland is in the wonderful position of having narrowed health inequalities. Could she perhaps compare and contrast what has happened in Scotland with what has happened in the rest of the United Kingdom? I rather think that the two are very similar.

If the right hon. Gentleman waits to hear the rest of my speech, I will highlight some of the differences in child poverty.

We have seen life expectancy for those women falling, but when we look at healthy life expectancy, the gaps are even bigger. Time spent in poor health is increasing, and that of course puts pressure on the NHS and care services. We in this Chamber are always discussing the pressure that the NHS is under. Emergency admissions in areas with low life expectancy are double the numbers in wealthier areas. Women in deprived areas will now spend two decades or more of their life in poor health. Improving the healthy life expectancy by at least five years was actually a policy in the industrial strategy, so that people could be active and engaged in the economy, but what we have seen is an adverse effect both on health and health equality.

We know that someone’s health for most of their life is determined in the early years, even starting when their mother is pregnant. Child poverty is central to this and it is rising. It is defined as children in households with less than 60% of median income. England had child poverty down to 27%, but it is now 31%. Scotland had it down to 21%, and it is now 24%. That is because welfare changes are taking place right across the UK. Poverty is decided in this Chamber; it is not decided anywhere else, and the Scottish Parliament, as we have heard, spends a lot of energy on trying to mitigate it.

As we know, housing costs are a major contributor because of the shortage of housing. This is a rising issue among the poorest: 38% of the poorest will spend 30% or more of their income on rent or housing. That figure was 28% 10 years ago. The Scottish Government have built 87,000 affordable houses, and that is part of why our child poverty level is lower. It is the housing impact. In the 2015 general election, the Conservatives promised 200,000 starter homes. They built precisely zero.

Some 4 million children are growing up in poverty, and that will affect their whole lives. Whenever the issue is raised at the Dispatch Box, we are told that unemployment is down and that people must work their way out of poverty. We are told that that is how we change things, yet two thirds of those children already have a working parent. The problem is that all of this drives ill health.

Does the hon. Lady agree that children living in poverty are more likely to suffer mental health issues? They face a double whammy, as the Children’s Commissioner recently found, in that there is also a postcode lottery in spending on children and young people’s mental health, which varies between about £15 and £200 per person, depending on the area.

I totally accept that, and actually, children in low-income families have three times the rate of mental health problems. Three-year-olds in a household with an income of less than £10,000 have two and a half times the chronic diseases, and by the time they start school, we find that the poorest children have over a year’s gap in vocabulary. It is important to try to balance that. That is one reason that the Scottish Government are investing in early learning for all children—all three-year-olds and four-year-olds and vulnerable two-year-olds—and also have put in a pupil equity premium that allows the school to have additional funding to try to meet the challenge where they are serving poorer communities.

The problem starts before the child is born. A woman carrying a female child is carrying her grandchildren, because the eggs in a female are formed in the womb. That means that if that mother is badly nourished, she will be affecting health for the next two generations. That needs to be changed, which is why we have invested. We have the best start grant, which goes to the pregnant woman at birth, when the child starts nursery and when the child starts school. There is also food support, because we need to change this right at the start of life.

Health and wellbeing should be an overarching priority for any Government and for all their citizens, regardless of where they live. This requires a “Health in all policies” approach, not saying, “Clean air is DEFRA’s issue.” We need this as a cross-government policy whereby every decision is checked to see whether it will improve the physical, mental and environmental wellbeing of the citizens the Government are responsible for.

Order. As colleagues can see, a large number of Members want to contribute to the debate. I am going to impose an immediate seven-minute time limit. I should also remind hon. and right hon. Members that, if they take interventions, that is likely to prevent others from speaking. Just bear that in mind.

Thank you for calling me, Madam Deputy Speaker, and I draw your attention to my declaration in the Register of Members’ Financial Interests as a practising NHS psychiatrist.

It is a pleasure to follow the hon. Member for Central Ayrshire (Dr Whitford), who is absolutely right to highlight the fact that health inequalities and their determinants go much wider than the NHS. We are talking about issues to do with housing, poverty and employment. We know that poverty and deprivation are associated with poor health outcomes, both physical and mental, and health inequalities.

In that respect, some of what I am going to say will ask the Government to revisit legislation that we passed as part of the Health and Social Care Act 2012 in relation to addiction services. That is where I shall concentrate my remarks, because we are all aware that addiction services treat some of the most vulnerable people in society, but face particular challenges and treat people often with some of the lowest life expectancies. In that respect, we must recognise that the changing commissioning arrangements, the move towards commissioning of addiction services by local government and some of the funding restraints that are present in the system have impacted on the quality of service delivery.

I shall touch on Dame Carol Black’s report later, but we have seen that, in some areas, there is now minimal provision in many addiction services, and local authorities often look towards the lowest bidder to provide their services. I hope Members on both sides of the House think that is not necessarily a good thing, because we want to see effective addiction services that make a difference for patients and for the people who need them. What we see, though, is that services have deteriorated over the past few years. Services have become increasingly fragmented, and the numbers of dependent opioid users and opioid deaths are rising. That may well be because there are greater medical comorbidities in that particular group, and the age profile may be associated with a higher mortality rate.

Dame Carol Black’s report makes some important points about the challenges. She includes a timeline that indicates how addiction services have been delivered, and she highlights that in 2005, under the previous Labour Government, a ring-fenced, pooled treatment budget was created, centrally funded and allocated on need. Additional funding contributions were made by local authorities, the police and the NHS. Funding increased from £50 million to nearly £500 million during the 2000s, which saw a step change in the ability of addiction services to respond to the needs of local populations.

The biggest change in the delivery of addiction services came with the Health and Social Care Act, in which responsibility for the commissioning of drug and alcohol services moved to local authorities. I do not need to rehearse many of the arguments, but it is worth highlighting some of the challenges we now face. A number of those challenges are a direct consequence of that change in commissioning arrangements.

Overall funding for treatment has fallen by 17%. It is not possible to disaggregate alcohol and drug treatment spend, but many local authorities will have reduced expenditure on drug and alcohol treatment by far larger amounts, with residential services—that is in-patient facilities—being particularly hard hit. The report says:

“Likely many areas are now offering the bare minimum service with large increases in worker caseloads an inevitability. The overall numbers in treatment have fallen at a similar rate as funding with the largest decreases seen in opiate users (and those in treatment for alcohol only).”

At the same time, we are aware from Home Office data that the prevalence of opiate and crack use is increasing and that the number of opiate users in treatment is falling, so there is a challenge for the Government to address in how those services are delivered and commissioned.

We should also recognise that many people who are in need of addiction services have two or more other complex needs. From Dame Carol Black’s report, we see that over 70% are unemployed, close to 40% also need mental health treatment, over 15% are homeless and over 25% have been referred from the criminal justice system. She states:

“Over 60% of opiate clients have two or more complex needs alongside their drug use”.

In the brief time I have left, it is worth reflecting that reduced funding is available to treat those people, but the commissioning arrangements mean that drug and alcohol services are commissioned by local authorities and are no longer integrated or joined up with the NHS, which makes it much harder to treat people with co-existent mental health problems; to find housing solutions, as the NHS does on a daily basis, for patients with a housing need; and to address some of the challenges we face in joining up and integrating care with the criminal justice system.

I hope the Minister will take away those challenges.

I am grateful to the hon. Gentleman —I am sorry, Madam Deputy Speaker, but I will be very brief.

The hon. Gentleman is making an excellent speech, and I agree with every word—I hope I have not ruined his career prospects by saying that. Does he agree that the way in which services are commissioned, and the lack of integration with wider mental health services, is leading to a problem in recruiting addiction psychiatrists into the sector?

Absolutely, and that key problem was also highlighted in Dame Carol Black’s report. I should refer to my declaration in the Register of Members’ Financial Interests at this point. I believe that in London there are only five training posts available in addiction psychiatry. We have a lack of addiction psychiatrists, of trainee psychiatrists coming through with accreditation in the area of addictions, of nurses with a specialism in that and of a properly trained workforce in addictions, as a result of the commissioning arrangements. That is a real challenge, and we have to address it.

Part of the reason for that is the separate commissioning pathway we now have through local authorities. It was flagged up as a challenge when the 2012 Act passed through this House, but the warnings given at that time have, unfortunately, come to fruition, and this is now causing challenges in the production pathway of addiction workers. The real challenge faced by the sector is that the people whom addiction services are trying to care for are now falling through the cracks of those fragmented services and the quality of service provision is not as good as it should be. I know the Minister will look at this constructively, but I hope it will be taken away and examined, so that we can see how we can put things in a better place for people experiencing alcohol and drug dependency, as they are often the people who have the greatest health inequalities.

Thank you, Madam Deputy Speaker, for calling me to make my maiden speech to the House today. To begin with, I want to pay tribute to my predecessor, Roberta Blackman-Woods. Roberta served the constituency for 14 years and was a tireless advocate for the people of Durham. Most recently, she was shadow Minister for Housing and Planning. Roberta was passionate about that work and highly respected for it. I want to say, on a personal level, that she has been a great help to me recently, and I wish her all the best in the next phase of her life.

It is an enormous privilege to be the Member of Parliament for the wonderful City of Durham. I want to thank the constituency Labour party members for their hard work and support in ensuring that I was elected, and the constituents who have placed their trust in me. I must also thank my family who have supported me throughout my life.

Durham has an incredible heritage. It is impossible not to be inspired when you see the cathedral on the horizon, and it is so central to the life of the city. It is fitting that the cathedral is now surrounded on all sides by the world-renowned Durham University, which is providing essential jobs and technology, linking Durham to all parts of the world, and giving our city a real vibrancy.

Durham has another history that needs to be celebrated: its mining heritage. It is a tradition that prides itself on resilience, forged by the trade union movement. All of that is encapsulated in the Durham miners’ gala, when banners from the villages that surround the city are proudly paraded through the streets, accompanied by brass bands. I hope that the right hon. Member for Surrey Heath (Michael Gove) has now learned that it is held in our constituency, which is very much still Labour.

To prepare for this speech, I read those of my predecessor, Roberta, and her predecessor, Gerry Steinberg, and it was fascinating. Gerry’s speech was made in 1987. He talked about the devastating levels of unemployment after the closure of the coal mines, and the refusal of the Thatcher Administration to tackle the resulting insecurity in people’s lives and work. This was a time of de-industrialisation, a widening north-south divide, trade unions being crushed, a run-down NHS and the poll tax on the horizon. In contrast, my immediate predecessor, Roberta, gave her speech in 2005, eight years into a Labour Government. She referred to unemployment being halved, the minimum wage, GCSE results improving, and a new state-of-the-art further education college being built, as well as a hospital and secondary schools. It could have been a different country.

Then I reflected on my life during those periods; these were the experiences that made me the socialist that I am. In 1987, I had just finished a youth training scheme. I was in insecure work, and shortly afterwards I was made redundant. My dad, too, was thrown on the scrap heap after Swan Hunter’s shipyards closed.

In 1989, my first daughter came into the world, born 10 weeks premature and needing a ventilator before she could breathe on her own. Unfortunately, this basic piece of equipment was not available at the hospital, nor was it available in any of the surrounding hospitals. This was a direct result of deliberately running down the NHS. Eventually, a ventilator was located 30 miles away and Maria was born three hours later by emergency C-section. She suffered brain damage and lived her whole life with severe cerebral palsy.

The policies of Governments greatly affect the lives of ordinary people. The actions of the Conservatives and their former coalition partners have seen the stalling of the increases in life expectancy. This is extraordinary and has not happened since 1900. Labour has been accused of wanting to take us back to the 1970s; well, the Conservatives have taken us back to the 19th century.

Last week, the Marmot report on health inequalities showed the impact of austerity—something that I have seen first-hand. In my constituency, a child born on the Sherburn Road estate can expect to live 15 years fewer than a child born in the most affluent parts of the city, just a couple of miles away. Even more shockingly, a recent report in the British Medical Journal showed that between the most deprived local authorities—including County Durham—and the rest, inequalities in infant deaths, which decreased sharply under the Labour Government, have now started to increase under Conservative austerity. Just what kind of society is being created?

There are families in the former pit villages of Ushaw Moor, Coxhoe, Brandon and others in my constituency who are trapped in poverty. Children and grandchildren of the miners who built the wealth of this country are now having to use food banks and undergo a cruel benefits regime. Is it any wonder that the police have reported that the main issue affecting these communities is male suicide?

Improving health in Britain is not just about refurbishing hospitals; it is about having a good education, a secure and loving home and a regular source of income. Until we address these social issues, we will not see any substantial changes in public health. As Professor Marmot says:

“What good does it do to treat people and send them back to the conditions that made them sick?”

Labour has a strategy—oven-ready, you might say—to tackle these injustices and build a fairer, more equal society. It was laid out in our manifesto. Unfortunately, we are not able to deliver it yet, but that will not stop us holding this Government to account or campaigning for a better society. My pledge to those who feel the harsh impact of Tory austerity—those who will feel health inequalities hardest—is that I will fight for them, because I have not come to this place just to lay out the problems: I and my party will be part of the solution.

The city of Durham is steeped in history, but it is the future we fight for. The motto of the Durham miners may be 150 years old, but it was adopted by people who also suffered defeats and setbacks but carried on their struggle and, over time, won improvements in their industry and in the lives of entire communities. The motto is still very apt, and it is one that I hold close to my heart as I start my parliamentary journey:

“The past we inherit, the future we build”.

I congratulate the hon. Member for City of Durham (Mary Kelly Foy) on her maiden speech. It was interesting; funnily enough I did not agree with a considerable amount of it, although that is to be expected.

I am the second working medical professional to speak, following my hon. Friend the Member for Central Suffolk and North Ipswich (Dr Poulter). We are both from the same party and speak with some knowledge of the difficulties that we face. The moment that this sort of debate comes up, health professionals from our own particular field have a go at us.

I was delighted that the Minister referred to child dental health, on which I feel a push from behind every time there is a health debate. When I first came to this country, I worked in a really deprived area of east London. Trying to treat children there was like trying to fill a bath with the plug out. The statistics for child dental health are still grim today: 23.3% of five-year-olds have tooth decay, rising to 33.7% in deprived areas. The rate drops to 13.6% in less deprived areas, but it is still bad. Tooth decay is the single greatest reason for hospital admissions for five to nine-year-olds. Last year, 25,702 children went to hospital because of tooth decay. Worse than that, 45,000 children and young people aged up to 19 went to hospital because of tooth decay.

The estimated cost of treating these children in hospital is about £50 million annually. Virtually all children will require a general anaesthetic. Every anaesthetic, especially for little ones, carries a risk—an unnecessary one. The cost is made worse because those cases occupy trained health professionals and hospital facilities that could be used for other NHS services. It makes me very cross because dental caries, as the Minister has said, are virtually entirely preventable. Put simply, the cause is acid from sugar and dental plaque. Britons eat about 700 grams of sugar a week—an average of 140 teaspoons. That intake is not spread evenly; it is higher in the north and lower in the south-east. As Members might expect, teenagers have the highest intake of all age groups, consuming, probably, about 50% more.

The Government are taking action and the sugar tax is helping. Sara Hurley, the chief dental officer, along with many charities and organisations, has a drive to teach children, even down to day nursery children, how to brush their teeth. It is helping but, as the Minister mentioned, far and away the best proven method to reduce tooth decay among children—and even, to some degree, among adults—is the fluoridation of the water supply. Fluoride increases the resistance of tooth enamel to decay dramatically. In the United Kingdom, approximately 330,000 people have naturally occurring fluoride in their water supply. Traditionally, another 5.8 million in different parts are supplied with fluoridated water, but that covers only 10% of the total population. The cover in the United States is about 74% and rising. In Canada, it is 44% and rising, in Australia, it is 80% and rising, and even little New Zealand has managed 70% and rising.

We do have fluoridation legislation, but it is left to local authorities to instigate the process and to compel water companies to fluoridate their water supplies. There is no financial advantage for local authorities if they take such action, but the savings that come through to the NHS are considerable.

The second problem with the legislation is that few local authority boundaries are coterminous with the boundaries of the water companies, which means that the direction and implementation get difficult, complex and sometimes nigh on impossible. To my mind, the simple and sensible answer would be for the application to be put into the hands of the Department of Health and Social Care so that the policy could be applied step by step across the country, going for the most deprived areas first. That is a big ask and it will require a brave Government, but from reflecting on the Labour party’s previous position on fluoridation, I would hope for Labour’s support.

Whenever I raise the issue of fluoridation, the green ink flies. Letters come in and broomsticks whizz around my house as people come up with extraordinary contrary points. The latest Department of Health figures show that the odds of experiencing dental health decay in fluoridated areas were reduced by 23% in five-year-old children in the less deprived areas, and by 52% in those living in the most deprived areas.

Water fluoridation reduces hospital admissions for dental extractions for children by 59%, and in deprived areas by as much as 68%. We have the opportunity to be world leading, to give our children this chance, and to combat health decay and children going to hospital.

Order. After the next speaker, I will reduce the time limit to four minutes in an attempt to get everybody in. It is a great pleasure to call Taiwo Owatemi to make her maiden speech.

Madam Deputy Speaker, thank you for giving me the opportunity to make my maiden speech in this important debate about health inequalities in our country. My constituents gave me the privilege to serve Coventry North West, and it is an immense honour to be here. I owe my amazing team of activists—and, most importantly, my constituents —a great deal.

I follow in the footsteps of a much loved member of this House, Geoffrey Robinson, who has been a fixture of the city and this Chamber for 43 years—long before I was even born. Geoffrey’s unwavering support for our local motoring industry was nationally applauded. During his final term, he was instrumental in changing the law on organ donations, which is something that I will continue to champion. I thank him for his service to our constituency, and wish him and his family the very best.

Coventry is a proud English city of culture, and my part of the city boasts incredible diversity. Our vibrant Irish and Sikh communities helped to grow Coventry’s booming industries after the second world war. Coventry was a major site for the UK’s car manufacturing. We hosted the likes of Jaguar Land Rover, Peugeot and the General Electric Company—for hon. Members whose memories can stretch that far. Indeed, we were a city that produced things, but that industrial base was almost wiped out overnight by Thatcher and her Government. The city has seen a lot of changes since the closure of these companies, but Coventry has always been an inclusive city—from university lecturers to students; from public sector workers to manual labourers. Even today, so many have made my part of Coventry their home.

My constituency is also diverse in the lay of its land—from the sprawling green country fields of Bablake approaching the villages of Keresley and Allesley to the west, to the cityscape further to the east—but at its heart is its community spirit. Across our six wards, residents are supported by numerous community centres and voluntary organisations with a common goal: to enrich and empower the community. As the first female MP for Coventry North West, I hope to follow in the footsteps of Lady Godiva and champion fairness. I am also the first MP of Nigerian heritage—specifically Yoruba —to represent a west midlands seat, and that is an honour that I carry with immense pride.

Many people would not have guessed this, but I am actually a twin. As a piece of trivia for hon. and right hon. Members, I can tell the House that in the Yoruba culture, every twin is named Taiwo or Kehinde, with Taiwo being the name of the first-born twin. My brother, mum and uncle are watching from the Gallery this afternoon, and I like to imagine that my dad and older brother Ayobola are looking down proudly from even higher up, in heaven, right now, too. I thank my family for all their unwavering support and encouragement.

My two fellow Coventry Labour MPs and I reflect the diversity, tenacity and strong values of Coventry. I look forward to working with them to advance Coventry’s cause during this Parliament, and to welcome the world as we celebrate becoming city of culture in 2021.

I am a churchgoing Christian, and my values—of community, family, inclusion, and never walking by when we see hardship—are grounded in my faith. I know that those values are shared by the people of Coventry, as Coventry is the city of peace and reconciliation. Those values are also Labour values. Indeed, I believe that everyone should have the opportunities they need to live a long, healthy and happy life.

The topic of this debate—health provision—is very close to my heart. Having lost my father when I was aged just seven, I became passionate about healthcare, and about supporting the dedicated professionals who sacrifice so much for us for so little thanks. But as a senior cancer pharmacist, every day I have seen our health service and adult social care system fail under continuous strain, without the resources they need. I was astounded to find out that the poorest in Coventry can live 18 years less than the richest in Westminster. We in Coventry deserve a better standard of care across the board, and I will be working with my colleagues in Coventry to fight for an urgent care centre so that we can have that better standard—I will always fight for that. Now that we have left the European Union, the Government can finally put their money where their bus is and properly fund the national health service, giving places such as Coventry the funding they need to provide good-quality healthcare.

Homelessness is becoming an increasing concern in our community, and Coventry has the largest food bank in the country. Although that reflects the good will of the people of Coventry, it also highlights the Government’s failures to help to cover the cost of living, and to invest properly in local emergency support for vulnerable people in crisis. Our housing is in crisis, too. At the core of every housing project should be genuinely affordable social housing, and legislation should require proper social infrastructure to be built alongside these projects. And, yes, we must also protect our green spaces.

Social mobility is a passion of mine. I believe that education provides a path to success. It astounds me that since 2013, pupils in my constituency have faced an 8.7% real-terms cut in funding. We are well below England’s average for educational attainment, and pupils with special educational needs and disabilities are often left behind, with inadequate provision to meet their needs. For too many young people growing up in my constituency, violence at home or on the streets is a reality, while West Midlands police and community services have faced severe cuts. This, too, can hold young people back. How can this Government claim to be the party of aspiration and opportunity when they stunt the growth and true potential of my constituents?

Coventry deserves the chance to thrive. It is in the nation’s interest that Coventry forms a central part of the midlands engine. Our history of technological and industrial innovation has created a natural home for world-class industrialists, researchers and academics—which, as I am sure the Government will agree, makes Coventry the obvious location for the environmentally sustainable Gigafactory. The midlands engine cannot run without the motor of a place like Coventry, and I will make sure that my city is never left behind.

As the MP for Coventry North West, I will ensure that every decision I make in this place is relevant to the lives of the people who put me here. I do not want to be known for extraordinary words in Hansard, but rather for the tangible difference my words make. I will be the MP who listens to her constituents about their concerns and aspirations. I will be the MP who protects our jobs and our beautiful green spaces, who stands up for good-quality homes and high-quality education, who sticks up for our NHS and protects the most vulnerable, and who fights for more police on our streets and opportunities for the next generation. I will spend my time in this House standing up for my constituents, for my patients and for the public services on which we all depend. My community in Coventry expects no less, and that is how I will serve it.

It is an honour to follow the hon. Member for Coventry North West (Taiwo Owatemi).

It should not matter where one lives in the UK in terms of leading a healthy lifestyle, but we must accept that sometimes there is poor health and the possibility of poor health. I am pleased to see that this Government are not shying away from the challenge, with record amounts of investment in our NHS, now enshrined in law—the largest and longest funding settlement in the history of the NHS. But we all need to start having an honest conversation with ourselves about closing the gap on health inequality, because it is one of the biggest challenges we face in this country. We need to start to admit to ourselves that we must make different lifestyle choices. We must think about the smoking and drinking we are all doing and the lack of exercise.

Loneliness is a big one for me. Loneliness is a killer. Far too many people in this country face life alone, whether that is due to their age, their disability, or just their own personal circumstance. In my community, we have the brilliant Huthwaite Hub, which is a charity I helped to set up four years ago with two brilliant ex-schoolteachers, Dai James and Geoff Jago-Lee. The idea was simple: get a big room, fill it full of woodwork machines, tools and materials, and then invite people who are socially isolated to come along and learn new skills. The community and local business really came together and donated everything we needed, and a lottery grant was the final piece of the jigsaw. The brilliant Huthwaite Hub has now seen hundreds of people come through its doors who otherwise would have been sat at home depressed and surviving on antidepressants. That facility is better than any tablet and has transformed the lives of many people in my area. I invite anybody in this House, and especially the Minister, to come and visit the brilliant Huthwaite Hub.

I sometimes get a little bit fed up with the Labour party using the subject of health as a political football. At the last four general elections Labour has put health at the top of its campaign agenda and has been rejected at the ballot box every single time. Just a few months ago, it suffered its biggest defeat since 1935, which, roughly translated, means, “The public just do not trust it.” Something very noticeable in areas like Ashfield and Eastwood, and in other similar constituencies throughout the country that have always been the victims of health inequality, is that they have always had a Labour MP and Labour-run councils—that is, until the election last year. As somebody once said, “Things can only get better”. There is a Budget coming shortly, which will see record amounts of investment in infrastructure all over the country, especially in places like Ashfield and Eastwood.

Does my hon. Friend agree that, to strengthen the resilience of local communities in combating health inequalities, it might be a good idea for the Government to set up a community wealth fund to be funnelled into some of the most deprived wards, such as Bridge ward in Ipswich, where the healthy life expectancy is around five years lower than the national average?

I completely agree.

As I was saying, the Budget will see record amounts of investment in places like Ashfield in Eastbourne. That will, in turn, create highly skilled jobs and better employment opportunities, which will turn the clock back on decades of decline. With this levelling up of wealth in places like Ashfield, I am positive that we will see a levelling up of health. If we are going to make the argument that poor places have poor health, the solution is simple: let us make the poorer places better off by providing better jobs, better education, better training and better opportunities in life, which will only come from a Conservative Government. Already in Ashfield, we have up to £75 million of town centre and future high streets funding coming. We are also looking at opening up old train lines, to increase connectivity. That sort of positive action in Ashfield will increase prosperity in health and wealth.

My wife is currently in Queen’s Medical Centre in Nottingham, after having her third operation in three years. She has had a double lung transplant, an operation to remove 2 metres of intestine and a good old bout of sepsis, and yesterday she had her gall bladder removed. When I told her that I was going to have this week off to look after her, she said, “No, you go down there to Parliament and tell them people in that Chamber that this is a brilliant NHS”—it keeps her alive every single day.

As I said, it is a shame that the Opposition are once again playing politics with a very emotive subject. I want to assure them that in places like Ashfield and other usually solid Labour areas across the midlands and north, we now have hard-working Tory MPs in place who will not only level up wealth but will level up health.

It is a pleasure to follow the hon. Member for Ashfield (Lee Anderson), whose area I know extremely well, and the fabulous maiden speeches on the Labour Benches, including from my hon. Friend the Member for Coventry North West (Taiwo Owatemi), who spoke most warmly about my city and about her predecessor; I concur with her comments.

Since 2010, the Government have chosen to implement unfair, regressive economic and social policies that have widened the gap between rich and poor, holding individuals back and leaving entire communities behind. Those policy choices have ensured that the last decade has been marked by widening health inequalities and deteriorating health. In Coventry, where poverty and deprivation are entrenched in some communities, the progress made in the years up to 2010 in terms of improving people’s life chances, quality of life and life expectancy have been derailed by this Government.

Over the last decade, people in our most deprived communities have experienced rising levels of in-work poverty, food insecurity and food bank reliance. They have found it more difficult to access good-quality housing and secure, well-paid employment, while their incomes and living standards have declined significantly. Public services and welfare spending, which would once have alleviated some of those pressures, have been slashed, removing a crucial safety net. That has an impact on not only people’s health but their ability to make positive healthy choices, which ultimately increases their chances of premature mortality and morbidity.

The evidence shows that there is now a life expectancy gap of 11 years between men living in the most deprived areas of Coventry and men in the least deprived areas, and the gap is 10 years for women. That gap has increased by nearly one and a half years over a five-year period. Those living in the most deprived areas not only die much earlier than those in more affluent areas; they also live much longer in poor health. Data shows that poorer men in the city will experience 17 years fewer in good health than their more affluent counterparts, while poorer women can expect 18 fewer years in good health.

Sadly, that is not altogether surprising when we consider the fact that some of the most deprived areas in the city experience higher rates of economic inactivity, fuel poverty and air pollution, while having fewer green spaces, all of which impact on people’s mental and physical health and wellbeing. Moreover, Coventry’s statistics on smoking, drinking and obesity show that 33% of adults who smoke live in the most deprived 10% of neighbourhoods; hospital admissions for alcohol-related illnesses and deaths are much higher than national rates; and overweight and obesity rates for children are higher than average.

We all know that tackling health inequalities is not a job that belongs exclusively to the NHS or to public health. To make a tangible difference, we have to improve our health and our health services, but we also have to look at our society as a whole and the conditions that determine our health. This is happening in Coventry, and we have had some notable successes, despite the poor hand we have been dealt by Government. For example, we have seen an increase in the proportion of children with good development by the end of reception year, and a reduction in the proportion of 16 to 18-year-olds not in education, employment or training. We have also achieved great results through employability support programmes, such as the Job Shop or Ambition Coventry, which work with people to help them secure employment.

However, if we hope to build on these successes, we need the support of Government. I hope the Minister will commit to funding public health, the NHS, local authorities and others properly, so that we can tackle the deep and entrenched health inequalities that exist in our communities and reduce the huge life expectancy gap between the richest and the poorest.

I am glad to be able to speak in this debate. Cornwall and the Isles of Scilly, which I represent, have a real issue with health inequalities, and I was glad recently to ask the Prime Minister to take a look at health inequalities in dental care. That has been touched on already this afternoon in relation to children. As I have said previously in this Chamber, 60% of adults in my constituency and across Cornwall and 40% of children have not seen a dentist in the past year. It is not so much a lack of funding—the funding actually gets returned to NHS England—as a lack of dentists prepared to work in the NHS. I am glad that the Government’s amendment states that they are

“committed to level up outcomes to reduce the health gap between wealthy and deprived areas, and supports the Government’s commitment to delivering long-term improvements for everyone no matter who they are, where they live or their social circumstances.”

Does the hon. Gentleman agree with me that part of the problem is the dental contract, whereby dentists are not rewarded for the amount of work they do and certainly not rewarded for preventive care?

I do agree with that. I did not want to get into party politics, but the Labour party gave the 2006 dental contract to dentists, and we have seen the decline in the availability of dental care in Cornwall from that point. I understand that it cannot be reviewed for another couple of years, but I believe there is work that can be done before then to respond to the challenge, and that is what I want to raise today.

Since I last raised this issue in the House, I have been asking my constituents about their experience. I have heard about disabled people who have to consider accessibility—they cannot get in to the dentist’s and therefore cannot get an appointment. Pensioners are unable to afford private treatment, and have been left stranded without provision for years. Some were getting NHS treatment, but then practices stopped offering it, as they are unable to keep up with demand. Pregnant women do not get access to NHS dental care for the entire pregnancy, but are offered it a long time afterwards, even though it is free during a pregnancy. People have ended up travelling further and further, and I heard of constituents travelling to Bristol and London to get the dentist care they need, which cannot be good for us as we try to reduce our carbon footprint. As I have said, there is also a lack of access for children.

In the time I have, let me share some of the comments that have been made. Mike left the Royal Navy and had a three-year wait for an NHS dentist. Then he got a dentist, but appointments have been constantly cancelled, so he is not seeing a dentist. He believes that the armed forces covenant should offer dental provision. Fred said that he has been waiting five years to get a dentist in Cornwall, so he is now registered at a London dentist, even though he lives in my constituency 300 miles away.

A gentleman who worked away a lot—his family was in Cornwall—said that he, sadly, did not visit the dentist for two years so was “removed” from the dentist’s list. He had cracked his tooth, but was not able to see a dentist, despite his wife and children still being registered and able to get an appointment. Another gentleman who had been living in Penzance for eight years had to wait two years to be placed at a dentist’s. He got a dentist, but then found that they kept cancelling, so he had not seen a dentist in three years. There is story after story of this happening.

There is light at the end of the tunnel. A lot of work was done last summer by the former MP Sarah Newton and me and other colleagues in Cornwall, and a plan was put in place. NHS England said that it would engage with the national NHS England dental workforce team to look at a more innovative way to attract dental staff to Cornwall and put forward a plan by the end of the year—that was last year. It also said:

“Work is also under way at a national level to identify solutions to the dental recruitment and retention pressures in NHS dentist services, and to understand and address the constraints of current national NHS dentist contracts”,

which has been referred to. I would like the Minister to look at what has happened to the plan Cornwall was promised at the end of last year and what is happening to the review that is going on across the county.

We are doing work locally, but it needs the commitment of Government and others. There is an irony in that we train a lot of dentists in Truro but they do not seem to stay in Cornwall so this also needs the involvement and commitment of the Peninsula dental school, as well as NHS providers and NHS England, to get a grip of this and to ensure that children and adults, particularly vulnerable adults, are no longer discriminated against and no longer face these health inequalities.

We must come together quickly and creatively to ensure that dental care provision is addressed. As we have heard, if we get it right very early in life then we save ourselves a whole host of problems later on.

In 1980, the Black report told us that the

“causes of health inequalities are so deep rooted that only a major and wide-ranging programme of public expenditure is capable of altering the pattern.”

The report was, famously, whisked out on a bank holiday. It was massively rejected by the then new Thatcher Government as being unrealistic in its expenditure levels— typically short-sighted and we have borne the cost of that since.

I learned about the findings of the report and the consequent discussions about health inequalities when I was at university, as quite a young person at that point. My lecturer, Professor Albert Weale, taught me a lot about health inequalities, which served to encourage me to seek a career in the NHS to make a difference. But the NHS contributes little if anything to reducing health inequalities, and many would argue that it in fact increases them: it makes them worse, with better-off patients finding access easier and being better able to navigate the systems—the sharp elbows. The inverse care law also applies: the best services are in the better-off areas. So I am always passionate about my career in and commitment to the NHS, but I have never deified it.

Progress was made in the last 40 years. In 1997 we, as the new Government, tried to tackle the social determinants of health, with healthy living centres, such as the one in my constituency in Knowle West, the new deal for communities, a focus on early years and families, smoking cessation, teenage pregnancies and sexual health services. We made a massive difference, but in 2011 the health inequality targets were removed. It is heartbreaking for me to see in my constituency the evidence-based work that we led in that Government destroyed by this Government, the shocking waste of human potential that has resulted, the huge personal and family and community loss, and the huge financial problem that that causes the Government in lost income and increased benefit payments.

The Treasury should be deeply concerned about the Marmot findings. The figures are stark; they continue to be stark. In report after report that I have read in my 30-odd years in the NHS and as an MP, we hear much about the north, but Bristol has neighbourhoods that are among the most deprived in the country, and the 10 most deprived neighbourhoods in Bristol are all in my constituency of Bristol South. Personal independence payment claims stand at 5,500, and those for carer’s allowance and live employment and support allowance at 4,907—all the highest in Bristol. One in 10 people of working age in Bristol South are not able to work because of health and disability reasons, and the joint strategic needs assessment also tells us that it is women who are bearing the brunt of this. Women in Bristol on average live in poor health for 22 years, which is higher than the England average. The health burden and the mortality and morbidity figures are equally stark, as Professor Marmot has highlighted.

In 40 years, we have learnt a lot, and if the Government are willing to use the learning we could have much better policy, but local government is key. Public health rooted in local authorities and using independent advice ought to be far more influential in issues around prioritising and resource allocation, overcoming the vested interests that are in the NHS.

Early intervention is key. The NHS does maternity and there is then a big gap until care of the elderly; local government has the interaction with children. The NHS focuses on individuals; local authorities focus on families and communities. NHS bodies are not coterminous with local authorities. They have no grounding in community, will be local authorities. Resource allocation in the NHS is driven by payment by results. Local authorities are much better at aligning resources with local needs. The NHS is not directly accountable to electors, which would make it better understand communities and social care. Unless the Government support local government, everything else is platitudes.

Good health and good healthcare are clearly the basis for happiness and prosperity for individuals and communities. As we have heard, many factors impact on health: some are personal and genetic; some are life circumstances, such as deprivation; and some are about the quantity and quality of health and care provision. But when this all comes together, we have a perfect storm. That is the plight of those who live in rural communities; my hon. Friend the Member for St Ives (Derek Thomas) alluded to that. Yet the 170-page Marmot report mentions the word “rural” only seven times, of which four are references to the Department for Environment, Food and Rural Affairs. So what do we mean by rural? It is interesting. It is not consistently defined. The Office for National Statistics, DEFRA and the Welsh Assembly all have different definitions. They are based on sparsity and deprivation, but they do not really look at the same thing. What is worse, data is analysed at a very high level. The cut-off is 15,000 heads of population. That really is not granular enough.

Density profiles look at rural towns, villages, hamlets and so on. The way they are built up, in blocks of population of 1,500, again does not really cut it. We have bizarre situations where High Peak is deemed only 55% rural, despite being right next to a national park, yet Sevenoaks, which I always thought was a big town, is 70% rural. It is very odd indeed. So there is a huge mask in the data in terms of what really is deprivation and where the need is. Therefore, the funding that is delivered to rural communities, certainly in areas such as mine, is based on the wrong assumptions. In calculating whether my constituents need money, there is a decision: do they have cars? Yes. That means they are affluent and do not need the money—wrong.

Does my hon. Friend agree that patient behaviour around rurality is different from those in the city? They have to make a decision when they are on their own whether to trouble the GP, to go out, to face the weather, to go to the hospital. When they really need to go, they leave it to the last minute. That creates an inequality that is not captured in the data.

My hon. Friend is totally right. There are some very big consequentials relating to the geography of our area and to the demographic profile. We tend to export young people and import older people. In consequence, we need more geriatricians. We do not need a lot of specialists; we need doctors who can cope with complex co-morbidities. We do not have doctors like that.

We need also more funding for primary care. Much of the funding is skewed towards accident and emergency. Why? Because that is where the measures are. We also need to look at how we overcome the infrastructure barriers. Road and rail, bad; 5G, great. But we do not have it. We ought to be a priority because that would be a real plus in trying to solve this rural problem.

We also need to train and recruit people who understand rural communities. If we do not train them in rural areas, they will not want to come and stay. Nurses working in hospitals and in social care need to be trained in a similar way and they need to be interchangeable, otherwise we cannot cope with the demand in social care. On mental health, as I think has already been mentioned, isolation and loneliness in rural areas mean that we have a very high level—I think the highest level—of suicide. We have lots of lone workers and lone livers. That is a real challenge.

The consequence of all that is that in Devon we find ourselves with some of the worst financial performance results and some of the worst results in terms of meeting targets. Why? Because we are being funded for the wrong thing in the wrong way. Nobody seems to notice that many in our community do not ever get ambulances. You try north Devon and parts of Cornwall—it is just not going to happen. The effect is that we are now in special measures. What does that do? Do we get help? Actually we get told to spend less. If that is not health inequality, I do not know what is. I hope the Minister will not tell me that people in rural areas live longer. It is not great to live longer if you are not in great health and the quality of your health really does not cut it.

This situation can change and it has to change. The Government need to accept that one size does not fit all. If the Government are willing to listen and to change, it can all happen.

I invite the Minister to come and listen to the evidence I am gathering while chairing a national inquiry into rural health and care. We are unpicking the issues. We are looking at evidence not only from across the United Kingdom, but from abroad—from New Zealand, Australia and America—of what good care looks like. We hope to provide the Minister with a toolkit for a good result. Thank you for listening.

I am afraid that after the next speaker, I will have to reduce the limit to three minutes. There have been interventions, which means that other people will have less time, so I urge people to be careful about interventions.

I really must praise the two excellent speeches by the hon. Members for City of Durham (Mary Kelly Foy) and for Coventry North West (Taiwo Owatemi). I rather fancy that those two Members will make their mark in this place in the years to come.

I want to tell the tale of Mr Billy Sutherland, who was a 63-year-old commercial traveller living in Wick. A good number of years ago, Billy set off from Wick on the A9, heading south. It was a winter’s day and the weather was not too bad when he left, but as he travelled further south towards the Ord of Caithness—the boundary between Caithness and Sutherland—it turned very nasty indeed. In the end, Billy drove into a snowdrift and could not get out of his car. The snow continued and eventually he was buried, in his car, 15 foot down. There was no trace of the car to be seen.

Billy was in that car for 80 hours. Eventually, the police found him by prodding the snow, and it clanged on the roof of the car. When they dug their way down to the car, they found that Billy was, astonishingly, alive and pretty well. He was not much the worse for his ordeal. Billy was a commercial traveller in ladies tights. As it got colder in his car over the 80 hours, he simply unwrapped more pairs of tights and put them on. It is an extraordinary tale. When he returned to Wick, he received a hero’s welcome.

I tell the tale because, until quite recently we enjoyed a consultant-led maternity service based at the Caithness General Hospital in Wick, but NHS Highland, in its infinite wisdom, decided to downgrade the service. As hon. Members know, because I have mentioned it before in this place, a great number of pregnant mothers now have to travel 104 miles from Wick to Inverness—a 208-mile return trip—to give birth to their babies. The vast majority of mothers have to do that.

What if it is winter? What if the ambulance gets stuck in a snowdrift? What if the mother’s contractions have started? What if the two emergency helicopters have been summoned to one road traffic accident in Lochaber and another in Morayshire? I have said it again and again: in my considered opinion, this is a tragedy waiting to happen. I make no apologies for raising it yet again in this place.

This debate is about equality of access to decent health services. I argue that my constituents in Caithness are losing out extremely badly indeed, and it annoys me intensely. In fairness, this is a matter that is devolved to the Scottish Government. I accept that and very much hope that the Scottish Government take the problem on board, because we cannot continue waiting for something dreadful to happen. When constituents come to me in Caithness, do I sit on my hands and say, “Well, it’s not a matter for Westminster,” or do I stand up and say something here? I make no apologies, because I think I owe it to the pregnant mothers.

It is a pleasure to follow the hon. Member for Caithness, Sutherland and Easter Ross (Jamie Stone).

The NHS long-term plan will be critical in tackling health inequalities. I welcome the announcement that the plan will deliver on this issue and address inequalities by working locally, specifically targeting areas of unmet need.

I am mindful that I live in and represent a constituency that has a life expectancy above the national average for men and women. However, there is an inequality within Guildford between those who live to the north of the A3 in the Westborough and Stoke wards, and those who live to the south of the A3, who can expect to live roughly five years longer than their northern neighbours.

I pay tribute to the excellent work that has been undertaken by the Guildford health and wellbeing board, which produced a report in 2017 that runs through to 2022. It was produced in partnership with the clinical commissioning groups, the local authorities and voluntary organisations, which are key to the implementation of important help and support on the ground in our community. I believe that empowering our community volunteers will be crucial in narrowing health inequalities.

The first priority outlined in that report was to support people to take responsibility for their own health and wellbeing as much as possible, and that principle must always be the starting point in tackling inequality of health outcomes. Committing to a prevention first approach is vital. If individuals are able, with support, to look at habits around smoking, alcohol consumption, food choices and exercise taken, there will be a huge impact on reducing not only physical health problems but mental health issues.

Local authorities do an excellent job of promoting their parks and recreation facilities and holiday activities for children. We expend so much energy on protecting our green spaces, so it is vital that we use them. Voluntary groups such as SMART Cranleigh are working hard in the social prescribing sphere, helping those who are socially isolated, which we know can have a detrimental effect on life expectancy, as my hon. Friend the Member for Ashfield (Lee Anderson) described so eloquently. Councillors have just opened a community fridge in Park Barn in my constituency, which stocks fresh vegetables, key to a healthy diet.

There will, however, always be those who need support and medical intervention, and the Government’s commitment to deliver £33.9 billion worth of investment in the NHS will make reducing health inequalities possible. I welcome that investment and trust that, with the excellent work already undertaken in the Guildford constituency on identifying areas of need, we might qualify for targeted support to improve the quality and length of life for my constituents who need it most. I am pleased to support the Government’s amendment this evening.

The £500 million promised by the Government for Epsom and St Helier University Hospitals NHS Trust provides the perfect opportunity to begin to address health inequalities in my part of south-west London. Instead, my local NHS has proposed moving services away from the most deprived areas to leafy Belmont, where life expectancy is longest. If that goes ahead, St Helier Hospital and Epsom Hospital will be downgraded, reducing two A&Es to one, with St Helier Hospital losing major A&E, acute medicine, critical care, emergency surgery, maternity services, in-patient paediatrics and child beds. That 62% reduction in beds would leave a shell of a hospital more accurately described as a walk-in centre.

Across the catchment of the trust, deprivation varies greatly. Given today’s debate, does the Minister agree that health inequalities must be at the heart of the decision on how to spend those funds? The key point is that of the 51 most deprived lower-layer super output areas in the trust’s catchment, just one is nearest to the chosen site. Meanwhile, 42 out of the 51 are nearest to St Helier Hospital. Any decision to downgrade St Helier, therefore, would exacerbate existing health inequalities. Rather than comparing deprivation by proximity to each of the three possible sites, it has been compared by CCG area, disguising the 76.5 year life expectancy of men in parts of Mitcham compared with the 84.4 year average in Wimbledon Park. The thousands of A&E attendances from the deprived areas in Croydon have been discounted, but the comparable number from prosperous Wimbledon have been included. The reality that the area of higher deprivation in the trust’s catchment area has, on average, a far higher attendance at A&E has been dismissed.

The Prime Minister’s amendment today states that the Government are committed to levelling up

“outcomes to reduce the health gap between wealthy and deprived areas”.

With just one month to go until the end of the St Helier consultation, the Government have a decision to make. Will much get yet more, or will the Government insist that vital services are left where they are most needed and any available funds are used to improve St Helier Hospital on its current site?

There is clear evidence that deprivation has a big impact on health and life expectancy. Preventing disease and encouraging healthy lifestyles are the key drivers in reducing poor health and early deaths in all communities, but particularly in more deprived areas. So much is known now that was not understood in previous generations about the importance of exercise, maintaining a healthy weight, stopping smoking, and eating fruit and vegetables. We may know what we need to do to give ourselves the best chance of staying healthy, but there are many barriers that prevent us from making those choices. Those barriers are far higher for people living in more deprived areas.

Low household income is a barrier to good health. If people are struggling to make ends meet, making sure that they eat their five a day and exercise three times a week is not an urgent priority, or perhaps is even affordable. That is why the Government’s commitment to raising the national living wage is so important. However, we know that there is more to do.

A second barrier is infrastructure. For many of my constituents in the rural villages around Penistone and Stocksbridge, it can take a whole day to travel to and from a hospital appointment in Sheffield because the buses are so few and far between. The Government’s commitments to improving bus services are vital to people who rely on public transport for access to healthcare. A further barrier is lack of information. Increasingly, health and medical information is going online, so we must tackle inequalities in digital skills and access.

There is much that the Government and our fantastic NHS are doing to tackle health inequalities, but there is also an important role for our families and communities in helping people to get and stay healthy. Community groups are vital in giving people hands-on and practical health advice and helping us to move towards healthy lifestyles. In my constituency, the Oughtibridge Strideout running club has helped many of my friends from the couch to 5k—although I am afraid I am still at the couch end of that. We also have Stocksbridge leisure centre, which is run by and for the community and is pioneering social prescribing.

As human beings, we exist not in isolation but in relationship to those around us. Relationships with our family, friends and communities are so important, and they are often our first port of call when we have health concerns. Breastfeeding support is a brilliant example. There is clear evidence that being breastfed improves a person’s chances of being healthy, but—I say this from lengthy experience—breastfeeding can be tough, and new mums need support from friends, family and community to keep going. I was lucky enough to have support from fantastic community groups when I had my first child, and I could not have kept going without that.

Levelling up our left-behind areas is not just about better buses and trains; it is about investing in communities. We need to make every effort to reduce health inequalities by funding our NHS, raising incomes, improving infrastructure and helping people gain access to information, but we must also recognise the importance of family, friends and community to our health, and I therefore welcome our manifesto commitments to a programme of strengthening families and championing family hubs.

I commend the speech of the hon. Member for Penistone and Stocksbridge (Miriam Cates), and also the two excellent maiden speeches from my hon. Friends the Members for City of Durham (Mary Kelly Foy) and for Coventry North West (Taiwo Owatemi).

I want to use this very short speech to promote the excellent work of the Haringey fairness commission. A number of local authorities have established fairness commissions to look into what can be done in their neighbourhoods. My hon. Friend the Member for Bristol South (Karin Smyth), who is not currently in the Chamber, spoke very well about the need for properly funded local authorities to have the key to addressing the need for high-quality early intervention, health and education services, and, of course, income. I think that if local authorities had a greater duty to stamp out the scourge of low pay, we would see a greater improvement in health. We know that 25% of people in Haringey are still not receiving the London living wage. If a quarter of our workers received that improved hourly rate, it would have a huge impact on their health.

We know from the work of the Equality Trust and a number of professors, including Professor Marmot from the Institute of Health Equity, that the problem is not just about people not having money in their pockets, but about the income gap. That applies to many of our London constituencies. Those who get on to the 41 bus at Turnpike Lane and travel west will go through areas where longevity increases by a couple of years for every mile travelled. There is currently six years’ difference between living in Turnpike Lane in the east of my constituency and living in Highgate village in the west. That is not acceptable.

This is the challenge that we face. It is not just about the fact that you do not have money in your pocket, but about the fact that the person sitting next to you may be doing very well, perhaps in owner-occupied housing and with a healthy pension, while you are still struggling to work into your 70s and also living with a chronic health condition. That is what inequality means, and I wonder sadly whether the covid-19 crisis will show just how unequal the virus will be in the victims whom it will tragically take. I fear that it will tend to be the people who are living with chronic obstructive pulmonary disease and other chronic illnesses who lose their lives, because of our health inequalities and because our services do not match the aspirations of Members on both sides of the House.

Let me once more commend the work of the Haringey fairness commission, which is hot off the press and which everyone can read online.

When considering how best to improve the nation’s health, including where inequalities exist, I have a natural tendency to want to go back to the very beginning and consider whether the experience of children can lead us to the answers. To that end, I want to raise the—literally—growing problem of childhood obesity. If we look at the overall statistics, we see that a third of children aged two to 15 are overweight or obese, and that 79% of children who are obese in their early teens will remain obese as adults. That puts them at risk of conditions including diabetes, asthma, cardiovascular disease, joint pain and cancer, but it also damages their life chances and can lead to psychological issues that can bear down on and impact their quality of life.

The causes are, as ever, multiple and complex: social, environmental, biological, personal and economic. Looking at the financial position of people, it is true to say that it is cheaper to fill a hungry child with doughnuts than with apples. Of course it is possible to eat healthily for less, but even here we see inequality. Research from University College London and Loughborough University in 2018 found that although childhood obesity had increased in recent decades, its rise had not affected children equally. The report concluded that

“the powerful influence of the obesogenic environment”—

that is, growing up in an environment that encourages or at least facilitates unhealthy eating—

“has disproportionately affected socioeconomically disadvantaged children”.

For example, the obesity figures for four to five-year-olds are at their highest among children from the most deprived areas, where 13.3% are obese, compared with 5.9% in more affluent areas. Although this is a long-running disparity, it is no less concerning, as these figures show. The seeds of a lifelong battle with obesity are sown at an early age, with one in five children already obese or overweight before they have even started school. Understanding the drivers and the most effective interventions is clearly going to be crucial to achieving the change that is needed.

That is why the measures that the Government have taken through the national childhood obesity plan, the Green Paper “Advancing our health: prevention in the 2020s” and the NHS long-term plan are important parts of the solution. We know that the soft drinks industry levy has been effective in reducing sugar content, with about 37.5 billion kilocalories removed from the soft drinks industry every year. We have the school food plan, and health education is now compulsory in our schools. We also have the primary PE and sport premium and the Healthy Start scheme, as well as the healthy child programme that we have heard about. All these measures are helping to tackle childhood obesity, but we know that there is a lot more to do if we are to meet our target of halving childhood obesity by 2030.

It is a pleasure to follow the hon. Member for Eddisbury (Edward Timpson). I would like to focus on one particular area of health inequality: the lack of access to NHS dentistry and the damaging effect that this is having on people’s health. I fundamentally believe that we cannot continue to treat dentistry as the Cinderella service of the NHS. It is underfunded, undervalued and in need of reform. There is a crisis in access to NHS dentists, and significant inequality in the availability of access. This is having an adverse effect on the health and wellbeing of our children, in particular, with tooth decay remaining the biggest cause of admission to hospital for five to nine-year-olds.

Unfortunately, there is a regional and socioeconomic divide in both the availability of NHS dentistry and in good dental health outcomes. Nearly 50% of children in the worst performing local authority area have tooth decay; in the best performing area the figure is just 4%. In Bradford, the figure is far too high at 40%. We also see wide regional inequalities of access. In Bradford, 88% of people who tried to do so got an NHS dental appointment, compared with 95% nationally.

Locally, I have had some success in campaigning for more investment in local NHS dental services. An access pilot scheme that ran in 2017 provided an extra 4,200 appointments. The scheme significantly cut waiting times for dental care in Bradford. More than half of those extra patients had not seen a dentist for more than two years. The “Stop the Rot” campaign with the Bradford Telegraph & Argus resulted in over £600,000 of clawback funding being reinvested in Bradford over three years. May I thank two former Ministers, the hon. Member for Winchester (Steve Brine) and Alistair Burt, for their help with this?

Will the current Minister take the hint and please confirm that, given the proven need, this reinvestment will continue into Bradford South? However, it is clear that this is not the long-term fundamental solution that is needed. First, we need to see reform of the dental contract, which is simply not fit for purpose. Secondly, the Government must get a grip on dental recruitment, which threatens to make access even harder. Thirdly, the Government must roll out the starting well programme across the country. Currently, it is limited to a handful of wards across 13 local authorities.

Finally, the Government must commit to fully funding NHS dentistry. It is operating on a budget that has remained essentially static since 2010. The scale of oral health inequalities in this country, in particular among our children, requires significant investment. The Government need to step up, never mind level up, and stop the crisis in NHS dentistry.

It is a pleasure to follow the hon. Member for Bradford South (Judith Cummins). I want to speak about autism and what the Government might do to improve outcomes and reduce health inequalities for people with autism in Peterborough and across the UK.

My interest in the subject stems from speaking directly with constituents, on the doorstep, who tell me about their experiences. I have joined the all-party parliamentary group on autism and support the National Autistic Society’s efforts to raise awareness of the condition.

Debates in Peterborough City Council chamber might not regularly excite hon. Members, but I hope that the House will indulge me just this once, because I am excited that councillors in Peterborough will tonight discuss a motion on autism tabled by the excellent Conservative councillor for Bretton, Chris Burbage. The motion will commit the council to engage with health and social care organisations, education, the police, charities, and people with autism and their families and carers, as well as with me and my hon. Friend the Member for North West Cambridgeshire (Mr Vara), in drafting an autism strategy.

I am proud of Peterborough and proud of the charities Autism Peterborough and the Enabling Independence Service, both of which I shall soon meet. I also want to mention my constituent, Nazreen Bibi, who cemented my interest in this area. She has done wonderful work and, despite standing to be a Labour party councillor in Peterborough in 2018, knows how we can work together for better outcomes for patients.

It is worth briefly reminding hon. Members what autism is. It is a lifelong development disability that affects how people perceive the world and interact with others. Not everyone’s brain works the same way. Autistic people see, hear and feel the world differently from other people. They are autistic for life; autism is not an illness or a disease, and it cannot be cured. Often, people feel that being autistic is a fundamental aspect of their identity. Autism is much more common than most people think, with around 700,000 people in the UK having this condition.

I want to focus my remaining remarks on getting an accurate diagnosis of autism, because that helps people, and their families, partners, employers, colleagues, teachers and friends, to understand why they might experience certain difficulties. It also helps them to get access to support services.

The Autism Act 2009 is over 10 years old. We have made considerable progress since that legislation was passed, but the APPG on autism has listed a series of recommendations on how the Government might do more in this area. I am confident that this Government will rise to the challenge on autism, and I ask Ministers to consider closely the APPG report and act on the recommendations within it.

Health inequalities remain acute in Ealing, with men and women in the most deprived areas living half a decade less than those in the richest part of the borough. We have also seen insidious rises in infant mortality, tuberculosis and winter deaths. For that to happen in one of the richest countries in the world, where we have come to expect incremental improvements in health, is a tragedy and the true legacy of 10 years of Tory misrule.

Ethnic minorities suffer from serious health inequalities, particularly with regard to organ donation. Last month I met a brave young boy from my constituency called Rohan and his wonderful mother, Sonia. Rohan is 12 years old and has been on the kidney transplant waiting list since 2018. The lack of awareness and insufficient promotion of organ donation in black, Asian and minority ethnic communities holds back young people such as Rohan from reaching their full potential. I can only encourage people to come forward and opt into the system.

The Government must also follow through on their overdue tobacco control plan White Paper to help to move us towards a smoke-free Britain. We need specific recommendations on oral tobacco, which disproportionately affects BAME communities.

The Government must also reverse the harsh cuts they have made to public health spending, which have made it far harder for local councils to provide evidence-led advice, particularly on mental health, sexual health, smoking cessation and drug and alcohol services. Public health spending is a small percentage of overall health spending, but it can have a drastic impact on the lives of the most vulnerable.

The Government must address overall levels of deprivation and urgently increase the minimum wage to a real living wage. I urge them to step up to their responsibilities and to do what they have promised: level up this country.

At the start of the debate, the Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Bury St Edmunds (Jo Churchill), asked for suggestions on how we can level up the health inequalities that affect all our constituencies. Representing the people of Ramsbottom, Tottington and Bury, I think the following policy proposals would go some way towards addressing the Marmot policy objectives.

First, in Bury, we need to strengthen our mainstream provision for primary-age children with autistic spectrum conditions and for children with social, emotional and mental health needs. We need to create two bases with outreach capacity to sustain pupils in their school with extra support, giving every child the best start in life.

We need to fund a learning disability hub, which would change how people with disabilities access support across Bury. This would involve the development of an accessible hub to provide information, advice, care and support to individuals whose lives are affected by disability, enabling all children and young people to maximise their capabilities and to have control of their life.

We need to create fair employment and good work for all. Bury College has received millions of pounds of Government investment for a proposed health and life sciences hub. We are now asking for further investment to create a digital and creative industry skills hub to provide the skilled jobs that my constituents need and to upskill all my constituents, no matter what their background.

Marmot’s main policy objectives relate to public health and prevention, and I ask the Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Mid Bedfordshire (Ms Dorries), to consider initiating a pilot in Bury for an integrated public health hub that would put all public health services together in one place. The hub would address substance abuse, as well as dietary and all wellbeing matters. More specifically, it would encourage a healthy and active lifestyle.

In Bury, we need to encourage people to become involved in sport and activity. Sites such as Gigg Lane, the home of Bury football club, are perfect facilities to inspire youngsters who are not involved in an active lifestyle to change their ways, and to become involved in their community and in a public health world to which they have not previously been introduced. Public health services should not be in an office block; they should be in open, attractive places that encourage young people to become involved.

Those proposals would have impact on my constituents, benefiting their health outcomes and life chances.

It is a pleasure to follow the hon. Member for Bury North (James Daly) and to hear his suggestions on how to reduce health inequalities.

Professor Marmot’s recent review on health inequalities since 2010 has highlighted how the Government’s decade of austerity has taken its toll on aspects of people’s lives. In particular, the report highlights: rising child poverty; the closure of children’s centres; declines in education funding; zero-hours contracts; increasing insecurity in work; the housing crisis; a rise in homelessness; an increase in the number of beggars on the street; people not having enough money to lead a healthy lifestyle; and more and more people turning to food banks. If those outcomes are not bad enough, things are even worse for our minority ethnic population, and that area is my focus in this speech.

Ethnicity has not been a consistent focus of health inequalities policy; very few policies have been targeted at minority groups. Two factors affecting the action—or the lack of it—on ethnic health inequalities are the availability of data on ethnicity and the legal obligations on racial equality. For example, data on ethnicity is not collected when a death is registered, so it is not possible to calculate life expectancy estimates. Having that data on ethnic groups in our health statistics would be an important aid to researchers, who would then be able to investigate differences in health. Education for our health professionals is also most important if we want to address health inequalities and to enable those professionals to feel that practical steps can be taken to help to reduce the inequalities. For example, sickle cell disorder affects some of my diverse community in Lewisham East, but not enough research has been done on it, and not enough time has been spent on evaluating the preventive measures and how to reduce people’s risk of having a sickle cell crisis. Clearly much more needs to be done to understand the disorder and how it disproportionately affects a section of our diverse population in the UK.

Many health professionals would agree that there is a desperate requirement to increase training on sickle cell disorder, as well as diversity training in the General Medical Council, the General Pharmaceutical Council and the Nursing & Midwifery Council, in order to address these needs. The Marmot review makes one thing clear: the effects of austerity are reducing quality of life and, in some cases, they are taking life.

It is great to see two Ministers on the Front Bench. For me, health inequalities are closely linked to the health of my local NHS trust, so I make no apologies for talking about Isle of Wight healthcare in relation to health inequalities. I do so within the framework of the unavoidably small hospitals programme, which is potentially a very interesting move by this Government. I discussed it with the Minister for Health, my hon. Friend the Member for Charnwood (Edward Argar) and the Secretary of State last week. The background is as follows: 12 national hospitals qualify as unavoidably small, and the economics of those hospitals has an impact on healthcare, especially in a place such as the Isle of Wight, which has a 100% remoteness factor, because we are separated by the sea. The diseconomies of scale over a wide range of health issues affect the ability to deliver healthcare to the same standard as on the mainland. That is part of the wider issue I am looking at when seeking an Isle of Wight deal. We reckon that the additional costs of providing healthcare on the Island to the same standard as on the mainland is about £12 million. I will not go further into the details, because of a shortage of time, but I have talked to the Secretary of State and the Minister for Health about that.

What do I intend to do about this? I am going to try to secure debates on the USH programme, in the hope that the 20 or so Members concerned, mostly Conservatives but with one Opposition Member, will join in supporting me, so that we can ensure that Ministers understand the additional pressures on these hospitals.

I will also make the case to Sir Simon Stevens for looking at increased revenue for unavoidably small hospitals, especially on the Island, which has a 100% remoteness factor. We will, though, continue to drive efficiency on the Island. Our chief executive Maggie Oldham and the leadership team are looking at doing that by linking up with Portsmouth district general hospital and with Solent NHS mental health trust, and by doing other good things so that we use public money as efficiently as possible.

I would very much like recognition from the Government that there is an additional cost for unavoidably small hospitals because of diseconomies of scale. That should translate into something in terms of revenue. In addition, when it comes to helping Islanders to get patient treatment on the mainland, there are additional costs for patient travel. I will leave it there.

Madam Deputy Speaker:

“Good health is an indication that a society is thriving and that economic and social and cultural features of a society are working in the best interests of the population”—

not my words, but those of Michael Marmot last week. It was hard to hear his conclusions on health equity 10 years on from his 2010 report, especially for those of us in the north-east, where we have seen the biggest declines.

In the Metropolitan Borough of Gateshead, which includes my constituency, the gap in life expectancy between the most deprived and least deprived areas has increased: in 2010-12 it was 8.6 years for men, but for 2016-18 it was 12 years; for women, the gap has increased from 8.8 years to 11.2 years. The gap in healthy life expectancy is even more stark: between 2009-11 and 2016-18, the gap in healthy life expectancy for women in Gateshead increased from 4.6 years to 6.2 years. Healthy life expectancy is a significant issue because it creates more pressure as people need support from the NHS and social care.

The Minister said earlier that local authorities need to and can take control of this issue; Gateshead has been doing so, as recognised by Michael Marmot. The North East Child Poverty Commission estimates that 209,272 children throughout the north-east are growing up in poverty. That is 6,224 children just in my constituency of Blaydon, or nine children in a class of 30, living in poverty. There is growing evidence that growing up in poverty has a devastating effect on children’s physical and mental wellbeing.

This morning, I attended the launch of the Royal College of Paediatrics and Child Health report on the state of child health in 2020. During the speeches, I was struck by the president of the college saying that it was too late for him to change his life expectancy—unless he takes up smoking and drinking, which he is not going to do—so he is focusing on the need to act for children. I was also struck by one of the things that the college recommended, which was for the Government to restore the money from the £1 billion real-terms cut to the public health grant for local authorities. It also recommended that funding should increase at the same rate as that for the NHS and be allocated based on population health need.

I would have liked to talk about smoking and alcohol, but time does not permit.

Health inequality is explicitly linked to the wider inequality caused by 10 years of austerity policies. Labour’s record shows that health inequality and child poverty—they are very much linked—are not inevitable and that Governments can address them effectively, but this Government have had a decade to do that and have simply not done enough. Huge health inequalities exist in my constituency. I shall concentrate on healthy food, housing and air pollution.

Roehampton includes areas that are among the 20% most deprived areas in England, and the 10% most deprived with respect to income and housing. Health levels in Roehampton are consistently lower than those in the wider London Borough of Wandsworth. Average life expectancy is 7.4 years less for men and 5.5 years less for women in Roehampton than in Thamesfield ward at the other end of my constituency. Men in the Alton and Putney Vale area of Roehampton spend up to 6.6 years fewer in good health than the Wandsworth average and women up to 4.9 years fewer. It is a scandal.

In one area of Roehampton, people feel like they are living in a food desert. These are urban areas where it is difficult to buy affordable, good-quality fresh food. That is a poor phenomenon across the country.

Cuts to transport and just having one small supermarket in an area are really big issues. That is a matter of town planning which could be addressed by the future high streets fund. Furthermore, more funding for councils could be used to help establish fresh food shops. Community organisations could also be used.

Linked to this is the high level of overcrowding in Roehampton. The biggest reason for people coming to my surgeries since I was elected is mould. Children growing up in homes with damp and mould are prone to asthma, and are often not able to go to school. Poor housing also means less physical activity, loss of sleep and missing school, and those problems are exacerbated in temporary accommodation where, often, there is no fridge, no cooker and no space to prepare food. I call for a public health review of our temporary accommodation.

Finally, air quality is not just a public health issue, but a social justice issue. Poorer families are less likely to have a car, but also more likely to live on the most polluted streets. To tackle this, we need a legally binding commitment to meet the World Health Organisation guideline levels for fine particulate matter; a strengthened Office for Environmental Protection; and targets and funding for councils to have a modal shift towards cycling and walking. These are public health issues. Residents of Putney, Roehampton and Southfields face health inequalities, and the Government need to start listening and take action.

I am proud to represent Enfield North, which is a key part of one of the fastest growing London boroughs and, like so many communities across London and the UK, it is a borough that is changing rapidly. The core funding Enfield Council receives from the Tory Government has been cut by an average of £800 per household since 2010, with hard-working Labour councillors having to find an extra £30 million this coming year. The impact that these swingeing, relentless cuts have had on our frontline services cannot be understated.

As I have said previously, I am pleased with the work that Enfield Council is doing to tackle health inequalities, but every single one of us across this House knows that the relentless attacks on local government have meant that its efforts provide only vital sticking plasters to the gross inequality that this Government have caused. People working in local government actually want to work with the Government to tackle the problems that we are talking about today. I pay tribute to the work of the Local Government Association in consistently raising the challenges that our councillors are facing.

The LGA rightly underlined that, when it comes to public health issues, almost every single function of local government has an impact on outcomes for local people. I wish to pay tribute to the work of Enfield Poverty and Inequality Commission for shining a light on this issue earlier this year, as part of its “All things being equal” report. The report made for difficult reading: 20,000 people living with unmet health needs; more than 15,000 people not registered with a local GP; and women living for up to 20 years in poor health. Why are we seeing damaging trends such as this? It is because injustice breeds inequality.

I ask the Minister today: why is it that residents in Enfield have less than half the public health funding per head compared with other London boroughs; why is it that 30% of children across our borough live in poverty; and why is it that only two thirds of people across our borough live in good health? We have to be honest about why this situation has developed and why many of the communities that I represent remain stuck in this vicious cycle. It is because the Government have wilfully neglected the changing needs of communities such as mine over the past 10 years. The failure to give us the funding and resources that people in Enfield need and deserve have damaged people’s life chances and pushed our public health progress backwards. It is time now for a step change. It is time that the Tories invested in the health of people across Enfield North.

This has been an excellent debate and one that I hope has been enlightening on the Government Benches especially. I thank all hon. Members who have contributed; I counted 24 Back Benchers in total. In particular, I pay tribute to my hon. Friends the Members for City of Durham (Mary Kelly Foy) and for Coventry North West (Taiwo Owatemi), who made exceptional maiden speeches and will be powerful advocates for their constituents.

I highlight the other excellent speeches by my hon. Friends the Members for Coventry North East (Colleen Fletcher), for Bristol South (Karin Smyth), for Mitcham and Morden (Siobhain McDonagh), for Hornsey and Wood Green (Catherine West), for Bradford South (Judith Cummins), for Ealing, Southall (Mr Sharma), for Lewisham East (Janet Daby), for Blaydon (Liz Twist), for Putney (Fleur Anderson) and for Enfield North (Feryal Clark), although time will not allow me to comment on them in detail.

As we have heard, “The Marmot Review 10 Years On” report confirmed what many Labour Members have been warning—that life expectancy is declining and inequalities are widening. The stalling of life expectancy is not a trend that we see worldwide. It does not have to be this way. The Nordic countries, Japan and Hong Kong all have life expectancies that are greater than ours and which continue to increase. But here in the UK, for the first time in more than 100 years, life expectancy is stalling and even declining for the poorest 10% of women. As the Marmot report says,

“if health has stopped improving it is a sign that society has stopped improving.”

There is no doubt that there is a link between austerity and stalling life expectancies. It is disgraceful that rates of premature deaths in poorer areas are twice as high as those in the more affluent areas. The Secretary of State has always said that prevention is one of his top three priorities, yet we have seen no evidence of that. The cuts to public health budgets have not been reversed. There has been no investment in children’s services, addiction services or social care, and no attempt has been made by successive Conservative Governments over the past 10 years to improve the standard of living for people living in cold and damp houses, working in unstable jobs or on zero-hours contracts, which have increased to more than 1 million people under their tenure.

The vulnerability of those on zero-hours contracts—sometimes with no rights to statutory sick pay—has come home to roost now that we are looking at a pandemic requiring two weeks of self-isolation, and possibly long periods off sick if the virus is contracted and takes hold. The same applies to the self-employed and those working in the gig economy. Although we welcome what the Prime Minister announced earlier today about scrapping the three-day wait for statutory sick pay, trying to live on £94.25 a week, which is about a quarter of the national minimum wage, will only exacerbate the existing inequalities, and could vastly compromise the nation’s attempts to contain the coronavirus if people choose to work, instead of self-isolating, due to the need to pay their bills and eat. The Government’s inaction to improve these inequalities in our society will not only continue to hurt the poorest and most vulnerable; in turn, the rest of society will also suffer. It is for those very reasons that Opposition Members believe in caring proactively for the most vulnerable. It really does benefit us all to do so.

Not doing something to make life fairer and more equal has real measurable affects. According to the Royal College of Physicians, children growing up in damp, mouldy homes are between one and a half and three times more likely to experience symptoms of asthma and other respiratory diseases than children living in dry homes. A study by the Nuffield Trust found that young people in the UK are more likely to die of asthma than in any one of the other 13 European countries studied. That is totally disgraceful, and the Government really must do something urgently to reverse this trend.

Holly Worboys died tragically at the age of 19 from an asthma attack in January 2016. She was using her inhaler sparingly to save on prescription costs. A prescription currently costs £9—a price that is just too high for many people who are living on squeezed or inadequate incomes. People should not be priced out of health. That is why we on the Labour Benches are committed to rolling out free prescriptions for everyone. Has the Minister considered this as a means to prevent illnesses worsening and early deaths?

The Marmot review confirms what we already knew: the poorer the area, the worse the health. That means that health inequalities also exist within poorer parts of otherwise wealthy areas, which we see across London often, but it also means that health inequalities exist between the north on the whole and the south— because, on the whole, the north is less affluent than the south. Sadly, it was ever thus and it is what drove me into politics in the first place, growing up in the north-east under Thatcher. The north is often a forgotten land, not least the north-east, where the most deprived 10% of neighbourhoods have seen the largest decreases in life expectancy. This is in comparison with the largest increases in life expectancy in the least deprived 10% of neighbourhoods in London.

When it comes to healthy life expectancy, as we heard earlier, boys born in Blackpool in 2016-18 can expect to live 53.3 years in good health, compared with 71.9 years for those born in Richmond upon Thames, where healthy life expectancy is the highest. That is a gap of 18.6 years and that gap has widened by 4.7 years since 2009-11, when it was 13.9 years.

This is a deep injustice that the Government must address as a matter of urgency. So what are they going to do about it? The public health grant has been cut by £700 million since 2015, with the most deprived areas faring worst. Will the Government reverse the cuts to public health budgets? Will they today—not “soon”, not “in the near future”—publish the public health grant allocation for 2020-21, so that local authorities can begin budgeting for the financial year ahead, which starts next month?

The Marmot review should act as a huge warning sign for the Government. Health inequalities are widening and life expectancy is stalling and declining. Given everything that we have heard this afternoon, what urgent steps will the Government take to address health inequalities before they increase further?

I thank all Members who have taken the time to attend this debate and to speak about their experiences and their concerns.

As my right hon. Friend the Prime Minister said in January:

“Every single person deserves to lead a long and healthy life, no matter who they are, where they live or their social circumstances.”

As someone who spent the first 20 years of my life in a council house in the 10th most deprived area in the country, I know more than most how important that is, and no one can concur with his sentiments more than I.

Before Professor Marmot published his report, this Government had already made clear our bold commitment to level up left-behind areas. This Government have been clear that they will address the needs of the communities that are being left behind, where too many people lose their independence through ill-health and disability. Differences in health outcomes are not new. Health inequalities have existed under successive Governments. In fact, it is worth mentioning that Marmot’s report in 2010 was equally damning of the record of the previous Administration. The hon. Member for Leicester South (Jonathan Ashworth) is shaking his head, but I am afraid it was. These reports are important, inasmuch as they push and inform Government policy going forward.

It is also worth mentioning, to add balance to the debate, that the ONS has published new life expectancy data, and the good news is that the latest figures show a bump up, as noted by Professor Marmot yesterday. We must, of course, take care with such information—those are provisional quarterly statistics and are subject to change—but it is good news that life expectancy figures are going up.

Differences in health outcomes are not new. Our manifesto pledged to increase years lived in good health and tackle specific problems—for example, by eradicating rough sleeping by the end of this Parliament. Those commitments came on top of an unprecedented level of investment in our NHS, with an unprecedented £2.3 billion in my area of mental health. There has also been substantial funding for our hospitals, primary care and workforce. Reducing inequalities requires action in the NHS and across Government, and prevention is a priority for this Government to support long, independent lives lived in good health.

Due to the time constraints, I will move on to answer some of the points raised by Members in no fewer than 24 speeches. I would like to commend and congratulate the Members who made their maiden speeches today. They were accomplished and excellent. I am sure that they will be a huge addition to the House, particularly in the area of health.

I would like to address the points made by my hon. Friend the Member for Central Suffolk and North Ipswich (Dr Poulter). We will develop and publish a new UK-wide cross-Government addiction strategy, which I am sure will be good news to him. The strategy will set clear goals to reduce drug deaths and dependency on drugs and will include problem gambling for the first time.

My hon. Friends the Members for Mole Valley (Sir Paul Beresford) and for St Ives (Derek Thomas) and the hon. Member for Bradford South (Judith Cummins) raised dentistry as an example of inequality. We are committed to increasing access to NHS dentistry. Some 21.8 million adults were seen by dentists in the 24-month period ending on 31 December last year, and 7 million children were seen by dentists in the 12-month period ending in June of the same year. The issue of water fluoridation is mentioned frequently by dentists, and the Government will be looking into that.

My hon. Friend the Member for Ashfield (Lee Anderson) mentioned loneliness and the importance of socialisation and social prescribing, which can have a significant impact on physical and mental health. Our loneliness strategy acknowledges that tackling loneliness is a complex and long-term challenge, requiring action on many fronts.

My hon. Friend the Member for Newton Abbot (Anne Marie Morris) raised the issue of inequalities in rural villages and towns. She made her point clearly, and I am sure that it has been heard. My hon. Friend the Member for Guildford (Angela Richardson) spoke about prevention, and I thank her for her recognition of the Government’s investment in the NHS and our commitment to deliver on the long-term plan.

The hon. Member for Mitcham and Morden (Siobhain McDonagh) spoke about St Helier Hospital. I am not qualified to give her a response, but her points will have been noted, and I will ensure that they go back to the Department. We will get a response to her, and I thank her for her comments.

I can tell my hon. Friend the Member for Penistone and Stocksbridge (Miriam Cates) that the NHS is setting up a national academy for social prescribing to champion social prescribing, which I am sure many Members will be pleased to know. Social prescribing can make a huge difference for people who are suffering from loneliness or other issues, so that they come together in the community.

I would like to conclude by thanking Members on both sides of the House. I would also like to thank Professor Sir Michael Marmot for his report on health inequalities. His dedicated work has shone a light on this important issue, not just now but back in 2010. This debate has demonstrated that this Government are facing up to the challenges and taking bold action to meet those challenges. We have invested over £16 million in public health over a five-year period, in addition to NHS spending on our world-leading NHS. We are making sure that—

claimed to move the closure (Standing Order No. 36).

Question put forthwith, That the Question be now put.

Question agreed to.

Question put accordingly (Standing Order No. 31(2)), That the original words stand part of the Question.

Question put forthwith (Standing Order No. 31(2)), That the proposed words be there added.

Question agreed to.

Main Question, as amended, put and agreed to.


That this House notes the publication of Health Equity in England: The Marmot Review 10 Years On, notes that Government is committed to level up outcomes to reduce the health gap between wealthy and deprived areas, and supports the Government’s commitment to delivering long-term improvements for everyone no matter who they are, where they live or their social circumstances.

On a point of order, Mr Speaker. On 24 February, during my speech in the Adjournment debate on the deaths of social security claimants since 2014, I incorrectly stated that Daniella Obeng had taken her own life. I would like to correct the record. In fact, Daniella died from bronchopneumonia. She also had a brain tumour that resulted in multiple epileptic fits.

Daniella’s family told me that she was a talented singer with a caring, supportive boyfriend and a wonderful 13-year-old son. After her social security support was stopped in 2016, she struggled to work because of her health conditions. Daniella managed to get a singing contract in Qatar for six months, but after just six days was found dead in her bedroom. The guitarist who was supporting her said that she was having fits during her performances and went to bed to recover. Unfortunately, she never woke up.

I offer my sincere condolences to Daniella’s family. She sounds an absolutely amazing woman.