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NHS Mandate: Health Inequalities

Volume 742: debated on Monday 28 January 2013

Question

Asked By

To ask Her Majesty’s Government what steps they are taking to reduce inequalities in health provision in line with the objectives of the NHS Mandate.

My Lords, legal duties in relation to reducing health inequalities will apply to the Secretary of State and NHS commissioners. Local authorities must have regard to reducing inequalities when commissioning public health services. The NHS and public health outcomes frameworks will be used to monitor progress. We are working across government to address inequalities through tackling the wider causes of ill health.

I thank my noble friend for her reply. In November, the BBC pointed out that the gap between the least served and best served people was widening in this country. Cancer Research UK pointed out in a recent survey that the likelihood of an unskilled worker dying of cancer was twice as great as that of a professional worker in the same region. In light of these figures, the Liberal Democrats proposed, and the Government accepted, a specific duty on the Secretary of State to have regard to inequalities in health. Despite that, the outcomes framework has among its five domains no reference to health inequalities and, despite the very strong support expressed by the public in the mandate consultation, there was no specific reference to inequalities in health in any of the recent DfH documents. Can I therefore ask the Minister directly whether she will agree that, when the review of the outcomes is made next year, a greater attempt will be made to have a specific section dealing with health inequalities and, one hopes, measuring real progress in this most difficult of areas?

My noble friend is right to focus on health inequalities that remain. The last Administration and previous Administrations have sought to address them, as have we. In the Health and Social Care Act 2012, for the first time there were specific legal duties to reduce health inequalities. I am slightly puzzled by what my noble friend says about outcomes, because if she looks at the public health outcomes framework and the NHS Outcomes Framework —in particular the public health ones—the two overarching outcomes are increased health life expectancy, and reduced difference in life expectancy and healthy life expectancy between communities. That is the measure against which we will judge what is done in public health.

Will the Minister accept that the proposals to close the excellent and much-admired accident and emergency hospital in Lewisham, and to downgrade its maternity services, have been made not because there is anything wrong with the hospital but because a government-appointed administrator has said that that should be done in order to help the neighbouring National Health Service trust, which has run up £130 million-worth of debt? Will she accept that closing and downgrading good facilities is an act of almost criminal stupidity, which leads to nothing but increased health inequalities when the Government’s objective is to reduce them?

The noble Lord might have heard his noble friend Lord Darzi comment on the difficulty of reorganising services so that they are as efficient and effective as possible. I would ask him to have a look at that.

My answer is that, as I have said, the Act puts reducing health inequalities at the centre; that is a responsibility at every level, and those things will be monitored in certain ways. As the noble Lord, who is winking at his colleague and perhaps not looking at me right now, might remember, the Secretary of State is answerable to Parliament and will be answerable for all these areas. If the noble Lord is right, and actions that are taken do not reduce inequalities, there will be an opportunity to hold the Government to account.

My Lords, the first priority in the mandate is about preventing people from dying prematurely. The Minister spoke about inequalities between communities, but I am concerned about two of the improvement areas mentioned in this priority, which are about reducing premature mortality in people with serious mental illness and people with learning disabilities. Will the Minister tell the House about the clinical leadership being put in place to ensure that these two areas are addressed energetically in order to reduce health inequalities within communities?

The noble Baroness is right to highlight this area. I point out that the NHS Commissioning Board has recently advertised nine posts which focus on health inequalities. I am sure that that kind of focus will help. The noble Baroness is right in that there are certain groups within communities that are particularly vulnerable. She will probably also be pleased to hear about the Inclusion Health programme, which focuses on particular groups which have particularly poor health outcomes, and which is chaired by Professor Steve Field, of whom she will be well aware.

My Lords, given that one aspect of the Government’s strategy to improve patient outcomes and reduce health inequalities is to encourage a shift from hospital-based to community-based care, will the Minister say what steps are being taken to address the shortage of district nurses, whose numbers have fallen by more than a third in the past decade?

I will write to the right reverend Prelate with numbers, as I have seen them but I do not have them in my brief here. I point out that because health will be far more focused in the local area, it is extremely important for the health and well-being boards, for example, to look at how health is delivered in their area. If there are problems because of a lack of staff, they will need to address that.

My Lords, would the noble Baroness care to correct a mistaken idea that she may have put to the House? I listened very carefully to my noble friend Lord Darzi, who said that his general comments about centres of excellence in no way related to the Lewisham situation, on which he was not commenting. Could she correct that, please?

The noble Lord commented on the difficulty of reorganising, which is what I have just highlighted, and it was in relation to the controversy over what is happening in south London. He explicitly said, it is true, that he could not comment on that case but it is extremely important in these cases that a strategic overview is taken of where provision is best set. The Department of Health is obviously well aware of what is said about the strength of accident and emergency at Lewisham Hospital. No doubt if that is a proved case, it will be necessary to bear it in mind.