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Health: Inequalities

Volume 700: debated on Thursday 3 April 2008

asked Her Majesty’s Government:

What plans they have to promote the use of health navigators to tackle health inequality, as proposed in the Turning Point report A Personal Approach to Public Services.

My Lords, we welcome Turning Point’s report and its contribution to the discussion on personalisation of public services. We are already making lifestyle advice and support on health issues available to individuals through NHS LifeCheck and health trainers. Tackling health inequalities is a top priority and we have the most comprehensive programme ever in this country to address them. We will be strengthening this by publishing a long-term health inequalities strategy later this year.

My Lords, I thank the Minister for that reply, but I stress the needs of people who have multiple conditions. Often, they have very many conditions, including long-term asthma and problems of that sort. Those who come from a particular community may also have language difficulties and therefore a problem knowing how to navigate in order to get the services that they need, be they health, social care or anything else. What additional support will be given to such people as individuals, which I believe the health advisers do not do? That would be invaluable in combating health inequalities.

My Lords, information is indeed important. Asthma UK is advocating the use of health navigators. That is a good example of the way in which health navigators, or indeed the health trainers, can provide information not only, in this case, on the use of inhalers but on help with paying prescription charges and on support in taking time off work to accompany children to their appointments. They can help people to negotiate a route through the complex maze of services to allow them to tailor those services to best meet their lifestyles and their needs.

My Lords, will the Minister define for the benefit of the House the intention behind, and role to be filled by, a health navigator? Will she say who is now doing the equivalent work?

My Lords, a health navigator, as defined in the Turning Point report, has deep knowledge and generic skills to understand the system across healthcare, benefits, housing and criminal justice. We are providing health trainers at a local level, while the provision of health navigators is being discussed. Health trainers are working with local, often hard-to-reach communities. Twelve hundred of them are in post already. Their job is to work across those communities, providing support, signposting to local services and advice on diets, smoking cessation, exercise and issues of mental health.

My Lords, does my noble friend the Minister agree that the Turning Point report in its call for the personalisation of services in the future sets a fundamental challenge for public services in their organisation and professionalism? Does she welcome the Prime Minister’s strong endorsement of this approach and of making progressive change in this way?

My Lords, that is absolutely right. Implementing personalisation of services across the boundaries of social care, housing, benefits, leisure, transport and health, with partners across independent, voluntary and community organisations, is vital. The report of my noble friend Lord Darzi recognises the relationship between health, social care and wider communities, which will be integral to the creation of a truly personalised healthcare system.

My Lords, so that these health navigators do not become like the sat-nav in my car and cause more confusion—I am obviously a little confused myself this morning—as people try to find their way through health and social services, will the Minister tell us a little about the pilot schemes that have been operating, whether they will be evaluated and whether that evaluation will be made public, so that we can see for ourselves the results of those schemes? In the light of the report on community pharmacists this morning, might they, too, have these health navigators on their premises, which seem to be the most accessible point for most patients?

My Lords, as the noble Baroness has clearly illustrated, several discussions are taking place about health navigators and health trainers. The health trainer system already exists, is being evaluated and is already delivering. For example, a former miner in Bolsover is working with the Bolsover Wellness scheme, which supports individuals and families, including people with diabetes and heart disease, across his own community. He is from that community and understands it; he follows the progress of those people; he is building his expertise and supporting the health needs of that community. The scheme is very practical and is being evaluated. One hopes that it will continue to be rolled out.

My Lords, will the noble Baroness accept that, some 25 years ago, the late Sir Douglas Black produced a comprehensive report on inequalities in health, the recommendations in which were rejected by the then Conservative Government?

Well, my Lords, many of the recommendations were rejected. Ten years ago, the former government Chief Medical Officer, Sir Donald Acheson, produced another report on inequalities in health, which in turn resulted in very few positive developments. May we be reassured by the noble Baroness that this important report and its recommendations will not suffer the same fate?

My Lords, my right honourable friend the Secretary of State, Alan Johnson, has confirmed that tackling health inequalities is central to the department’s work. The current national inequalities targets run till 2010. We are publishing a strategy this year which will draw on those reports. This is absolutely a priority.

My Lords, in looking at health inequalities, should not the Government have as one of their first priorities a review of the resource allocation formula? For example, spending on cancer in Oxfordshire is £5,182 per head, while cancer patients in Nottingham receive £17,028 per head. Does the Minister think that that large difference in funding is purely and simply a reflection of the burden of disease, or might there be something wrong with the formula?

My Lords, the incidence of cancer deaths—the second biggest cause of the inequality gap—is linked to geographic areas. In the areas of highest deprivation there is late presentation, and the investment has to go into the care in those areas.