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Health Inequalities: Office for Health Improvement and Disparities

Volume 707: debated on Wednesday 26 January 2022

[Derek Twigg in the Chair]

Before we begin, I remind hon. Members that they are expected to wear face coverings when they are not speaking in the debate. This is in line with the current Government guidance and that of the House of Commons Commission. I remind Members that they are asked by the House to have a covid lateral flow test before coming on to the parliamentary estate. Please also give each other and members of staff space when seated and when entering and leaving the room.

I beg to move,

That this House has considered the Office for Health Improvement and Disparities and health inequalities.

It is a real pleasure to be here under your stewardship this afternoon, Mr Twigg. I thank all those who have come along—all on the Labour side of the House—to debate this important issue, which affects so many of our constituents. I thank the organisations that have provided me with information to help me articulate my points, including the Royal College of Physicians, the Inequalities in Health Alliance, the British Heart Foundation, Cancer Research UK, Maternity Action, the Royal College of Paediatrics and Child Health, the NHS Federation, the UK Vaping Industry Association, Kidney Research UK, the Health Foundation, the Terrence Higgins Trust, Global Blood Therapeutics, the Local Government Association, the Institute of Alcohol Studies, the Children’s Alliance and, as ever, the House of Commons Library, which brings much of this together. I do not believe I have missed any organisation out. If I have, I apologise.

Each organisation made helpful and constructive comments about the matter we are debating today. The extent of health inequalities is remarkably wide—in fact, I felt I understood the extent of such inequalities, but the information from those organisations has widened my knowledge significantly. Each of the organisations had the decency to send me information, so I will read out comments from each of them, if I may.

Alongside its key ask for a cross-governmental strategy to reduce health inequalities, the Inequalities in Health Alliance also asks the Government to

“commence the socio-economic duty, section 1 of the Equality Act 2010”

and to

“adopt a ‘child health in all policies’ approach.”

The Health Foundation notes:

“Public health funding grants to councils have been reduced by £700 million in real terms from 2015/16 to 2019/20. In the Spending Review published in October 2021, the Government said it would maintain the public health grant ‘in real terms’ until 2024/25, but has yet to confirm the amount for 2022/23.”

We are only a couple of months away from the beginning of that financial year. The Terrence Higgins Trust asked me to ask whether the Minister can confirm when local authorities will have their public health grant allocations published. Other organisations also asked that question.

The Institute of Alcohol Studies said:

“People from the most deprived groups in England are 60% more likely to die or be admitted to hospital due to alcohol than those from the least deprived… We believe that for any levelling up agenda to be comprehensively successful, it must address alcohol harm as a top priority.”

The LGA said:

“Councils have seen a significant reduction to their public health budgets in the period between 2015/16 and 2019/20. The recent announcement of a real-terms protection of the public health grant is welcome, but is unlikely to address the impact of the past reductions to funding.”

Cancer Research said that its modelling estimates suggest that

“30,000 extra cases of cancer in the UK each year are attributable to socio-economic deprivation. The two biggest preventable causes of cancer—smoking and overweight and obesity—are more prevalent in deprived groups.”

Kidney Research said:

“Around 3 million people in the UK have kidney disease and every day, 20 people develop kidney failure…. There is also a gender bias associated with kidney disease—women are more likely to be diagnosed with kidney disease and are at higher risk of developing end stage renal failure than men.”

My hon. Friend is making an excellent speech. On that point, I want to ask him about gender inequality in terms of health. As a member of the all-party parliamentary group on osteoporosis and bone health, he will know that fracture liaison services are key to prompt and timely diagnosis of osteoporosis, but only 51% of NHS trusts in England have an FLS and only 41% of all NHS trusts have permanent and sustainable funding in place for their FLS. That means that every year an estimated 900,000 people miss out on the medication they need to prevent avoidable fractures. Does he agree that this health inequality, or postcode lottery, needs to end?

My hon. Friend is completely right and she has been a real champion of osteoporosis services, pushing them in her own area and as chair of the APPG. One figure shows that half of women over the age of 50 suffer a broken bone due to osteoporosis. That is the kind of stark figure that we have to face. I thank my hon. Friend for that intervention.

The NHS Confederation has made comments similar to those I have mentioned:

“The number of people waiting for planned NHS care in England has grown to record levels, with more than 5.6 million people currently on the waiting list and over 7 million ‘missing patients’ anticipated to come forward... Inequalities are now becoming evident in the backlog, with evidence suggesting that waiting lists have grown more rapidly in more deprived areas during the pandemic.”

Maternity Action says:

“Vulnerable migrant women face charges of £7,000 or more for… maternity care. Charges are levied on women with insecure immigration status, including destitute asylum seekers whose claim has been refused and who are not in receipt of Home Office support, women whose relationship has broken down and who were dependent on their partner for their immigration status, women on fiancee visas and women who have been unable to afford to renew their visas. This policy disproportionately impacts on minority ethnic women, who make up 85% of women using Maternity Action's Maternity Care Access Advice Service, which advises women”

on such matters.

The British Heart Foundation said:

“The prevalence of heart failure, stroke, and mini stroke in adults with learning disabilities in England is higher than the general population, and circulatory diseases are one of the main causes of death in people with learning disabilities. For the most part, this can be attributed to differences in the social determinants of health.”

The Royal College of Paediatrics and Child Health said:

“Child health outcomes in England are some of the worst in Europe… Our State of Child Health 2020 report reveals a widening gap between health outcomes across nearly 30 indicators. It shows that children living in more deprived areas have worse health outcomes than their peers living in less deprived areas… The COVID-19 pandemic has also highlighted and accelerated the devastating impact of health inequalities.”

My hon. Friend is making an excellent speech. Does he agree that, given that the largest number of covid-related deaths have been experienced by ethnic minority communities, it is imperative that the Minister provides clarity on whether the Office for Health Improvement and Disparities and the Health Promotion Taskforce will be given a remit outside the Department for Health and Social Care?

I am pleased that my hon. Friend asked that question, because it is one that has been asked many times, and I am sure the Minister will cover it—it is one of the questions I have as well.

The UK vaping industry said:

“It is absolutely critical that the new Office for Health Improvement and Disparities continues the pragmatic approach of Public Health England in recognising the role of vaping in tackling inequalities. It is essential that the institutional knowledge of PHE is not lost in the establishment of the OHID”

It is important that that is factored into these debates.

The House of Commons Library referred to the debate on health inequalities versus disparities. Jabeer Butt of the Race Equalities Foundation has welcomed the institution of the OHID and the possibility of working alongside it, but he said:

“With the establishment of OHID, we can’t help but wonder why the language used by the Health and Social Care Secretary talks about ‘health disparities’, compared to Professor Chris Whitty, who describes ‘health inequalities in the Government announcement.”

This is not just about semantics. It is important that we recognise that it is about not just disparities but health inequalities as well.

I commend my hon. Friend on his speech. He touched on a really important point: that the Government talk about disparities when they should talk about inequalities. To truly tackle health inequalities, we need to look at social factors, such as housing, racism and air pollution, and socioeconomic factors. Does he agree that, to tackle all of those inequalities, the OHID will need to look in the round at all those issues and seek a cross-governmental role to deliver on the Department of Health and Social Care’s aims?

My hon. Friend is spot on. That is a key point that we want to tease out today: cross-departmental working.

As with many other health issues, the devil is in the detail. Only by looking into the granularity of the issues can a real understanding of the levels of inequality and disparity be established. I do not have time for more significant references to the organisations concerned, but it really was important for me to get down to the detail of the information that they provided. I will give the documents to the Minister for her perusal in due course.

Before the pandemic, growth in life expectancy had stalled for the most deprived in England. Between 2014 and 2019, people in the least deprived areas saw their life expectancy grow significantly, but there were no significant changes for people in the most deprived areas. For women in the most deprived areas of England, life expectancy fell between 2010 and 2019—a stark fact. The pandemic unambiguously exposed and exacerbated inequalities that have existed in our society for far too long, as many hon. Members will have seen first hand in their constituencies. The pandemic has widened gaps that were already too big to begin with, and once again it is the most vulnerable who have borne the brunt.

We know from the Sir Michael Marmot’s “Build Back Fairer” report that mortality rates for covid in the first wave mirrored mortality rates for other causes. In order words, the causes of health inequalities more widely were similar to the underlying drivers of covid-19 deaths among certain groups. It has been estimated that working-age adults in England’s poorest areas were almost four times more likely to die from covid than those in the wealthiest areas—another stark figure. Now, with the backlog, analysis of waiting list data shows that people living in the most deprived areas are nearly twice as likely to wait more than a year for treatment compared to those living in the least deprived areas. That cannot be right.

Before the pandemic, through the pandemic and now as we emerge, we hope, from the worst of the omicron variant—it is clear that there is a deep-rooted inequality in our society that causes huge inequality in health. The gap in life expectancy is startling. People in my constituency live on average 12 years less than people in Southport—just at the other end of the borough. Those are stark differences in healthy life expectancy—how many years a person spends in good health. Before covid, it was estimated that people in the richest communities in England could expect to live in good health for up to two decades more than the poorest. In Bootle, according to Nomis at the Office for National Statistics, 42% of people who are economically inactive are long-term sick, compared to the national average of 24%.

However, statistics get us only so far. A recent paper from the Royal College of Physicians brings to life the reality of health inequalities. One hospital clinician saw a patient who was extremely malnourished and dehydrated. The patient had been regularly missing meals so she could feed her teenage son. When she first became unwell, she did not call the GP, because she was unable to afford to pay someone to look after her son, and was frightened that he would be taken into care if she had to go to hospital for a long time. She was eventually admitted to hospital with sepsis. There are other stories in the paper of people who missed hospital appointments because they could not afford public transport, people who do not have the kitchen facilities to cook food and someone who was hospitalised because their asthma was aggravated by mould in their flat that the landlord refused to fix.

As we all know, 40 years ago, Sir Douglas Black, a former president of the Royal College of Physicians, was asked by the Department of Health and Social Security to lead an expert committee looking into health and inequality. That now famous Black report was unequivocal and said that while overall health had improved since the introduction of the welfare state, there were widespread health inequalities, the main cause of which were economic inequalities.

In his foreword to the report, the then Secretary of State said:

“the influences at work in explaining the relative health experience of different parts of our society are many and interrelated.”

That is as true today as it was then. It might seem that health inequality is a matter for the Department of Health and Social Care and the NHS but, as other hon. Members have said, health and social care services can only try to cure the ailments created by the environments people live in.

Research by the University of York linked austerity measures with the deaths of almost 60,000 more people than would be expected in the four years following their introduction. The money a person has will change the decisions they make about their health. It is the difference between having a healthy meal and having a meal at all, or between choosing to pay for the journey to the GP for an ongoing cough or choosing not to.

Housing affects health too. Last year, Shelter found that poor housing was harming the health of a fifth of renters. Our society benefits some people and deprives others, and those structural inequalities drive many of the health inequalities in black, Asian and other minority ethnic groups. We have to address that if we want to tackle this issue.

If we are to prevent ill health in the first place, we need to take action on issues such as how much money people have, poor housing, food quality, communities, place, employment, racism and discrimination, transport, and air pollution. That is why many organisations and coalitions, including the 200 members of the Inequalities in Health Alliance, which is convened by the Royal College of Physicians, have made calls for a cross-Government strategy to reduce health inequalities.

Tackling health inequality requires a considered and co-ordinated approach across myriad factors. Last year, the Government signalled that they recognise the need to look beyond the Department of Health and Social Care and the NHS and to take action on the issues that cause ill health. When the Secretary of State announced the Office for Health Improvement and Disparities in October last year, we were promised a new cross-Government agenda that would look to track the wider determinants of health and reduce disparities. The Health Promotion Taskforce was established.

These are potentially encouraging signs, but I am concerned that we are yet to hear the detail of what the OHID will do to reduce health inequalities. Will the Health Promotion Taskforce have a remit to take action outside the Department of Health and Social Care? When will we see a strategy on reducing health inequalities, so that we know what the Government’s ambition is in this area and we can track progress? Will the Government commit to developing a cross-Government strategy to reduce health inequalities?

Will the Minister set out how the Office for Health Improvement and Disparities will reduce health inequalities? Will he tell us about the work of the Health Promotion Taskforce and how often it meets? What engagement has the OHID had with Government Departments to date, since it was formally established on 1 October 2021? Importantly, will the Minister set out how the OHID will work with integrated care systems and support them to address health inequalities in their areas? I hope he can answer some of those questions.

When the Labour Government first asked Professor Marmot to review health inequalities in 2008, Gordon Brown said:

“The health inequalities we are talking about are not only unjust, condemning millions of men, women and children to avoidable ill-health. They also limit the development and the prosperity of communities, whole nations and even continents.”

He was absolutely right.

This Government were elected on a platform of levelling up, but while covid-19 caused a decrease in life expectancies for most countries between 2019 and 2020, the UK’s life expectancy has fallen below where it was in 2010. The UK was one of only two countries where that happened, the other being the United States.

In 1980, the Government responded to the Black report by saying:

“you might be right about the solution, but it’s going to cost too much.”

After two years of living with the pandemic, which, of course, has hit the most deprived the hardest, it is clear that the real cost lies in not supporting those who need that support most. Only Government can create the conditions for better health by improving the factors that lead to ill health in the first place. I hope the Minister can set out what the Office for Health Improvement and Disparities can do to achieve the aim of reducing inequality, and can confirm that the Government intend to tackle the wider determinants of health, which drive so much of the health inequality that we see.

A good number of Members want to speak today. I do not intend to impose a time limit, but it would helpful if you could keep your speeches to around six minutes. That will ensure that everybody gets in. I intend to call the Front Benchers at no later than 3.40 pm.

I will keep my mask on because I have a wound, unfortunately, which I need to keep covered. It is an absolute pleasure to serve under your chairmanship, Mr Twigg. I remember that we served on the 2012 Health and Social Care Bill Committee together, so this is bringing back memories.

I congratulate my hon. Friend the Member for Bootle (Peter Dowd) on his excellent speech, and particularly on his focus on the wider health determinants and the need for an intergovernmental strategy and co-ordination. He is absolutely right.

I sought to become an MP because of my work on health inequalities. I was at the University of Liverpool for 10 years. Prior to that, I was a jobbing public health consultant. My hon. Friend mentioned the Black report. We must not forget that Margaret Whitehead at Liverpool was the first person to identify the health divide between the north and south. I am grateful to her. I learned so much under her and my other colleagues at Liverpool.

In the time that you have made available to me, Mr Twigg, I want to make three points. First, health inequalities are not inevitable. We hear “Oh, it’s always been there; it’s never going to change”. They are not inevitable but a consequence of political choices. As my hon. Friend said, those choices relate to whether or not we want socioeconomic inequalities to continue. It is also about—and this is rarely talked about—inequalities in power. We must ensure that that is addressed and brought into the debate.

Secondly, the structural inequalities across our country have been exposed and exacerbated by covid, resulting in, as Professor Sir Michael Marmot has said,

“the high and unequal death toll from COVID-19”,

which was one of the highest in the world. Thirdly, tackling health inequalities involves every single Government Department, not just the Department of Health and Social Care.

The term “health inequalities” refers to the increasing mortality and morbidity that occurs with declining socioeconomic conditions. In my Oldham East and Saddleworth constituency, the health inequality gap is more than 12 years. Those health inequalities are systematic and socially produced, and are a result of the differential distribution of income, wealth, knowledge, social status and connections. There is overwhelming evidence that those factors are the key determinants of health inequalities, influenced by written and unwritten rules and laws across our society, rather than biological and behavioural differences. I have always been disappointed by the focus always being on the individual: “It’s your fault if you get ill; it’s your fault if you get a disease. It’s your lifestyle choices.” It is not. There is overwhelming evidence on that.

There is no law of nature that decrees that the risk of a baby dying is 94% higher for children born into poor families than for those born into rich families, but that is the reality. We know that infant mortality, which had been declining for nearly a century, has started to rise again. As my hon. Friend has said, there are consequences to inequality and the austerity that has been imposed on so many families.

To my first point, given that health inequalities are socially produced, there is hope because that means that they are not fixed or inevitable—we can do something about them. If the Government are committed to levelling up, will the Minister comment on why the Gini coefficient has increased over the past few years? As my dear friend Frank Dobson famously said, nothing could be more unjust than someone knowing that they are going to die sooner because they are poor. Will the Minister comment on the socioeconomic factors that are driving health inequalities? Why they have they got worse over the past two years?

On my second point, Sir Michael Marmot was very clear in his analysis of the covid death rate that there have been four drivers of the high and unequal death toll in the UK: the governance and political culture detrimentally affecting social cohesion and inclusivity; the widening inequalities in power, money and resources; the regressive austerity policies over the past decade; and the declining healthy life expectancy of the poorest, particularly women, which is among the worst of all comparable economies. Deprived communities have also been hit particularly hard in that regard.

On my third point, as important our NHS is in treating and caring for us when we get ill, reducing inequalities must involve all Government Departments, as my hon. Friend has said. That was reflected in Sir Michael’s recommendations to address those inequalities. He said that we must build back fairer from the pandemic, with multi-sector action from all levels of Government, and increase investment in public health. Since 2015, there has been a 24% cut in public health budgets.

One thing we know about the NHS and its impact on inequalities relates to the privatisation and marketisation of health services. We know that that helps to reduce access to health services for those on lower socioeconomic groups. On top of that, there is the inequality in health outcomes. I fear that the 2021 Health and Care Bill will make a bad situation even worse, adding to the issues resulting from the Health and Social Care Act 2012.

Not only do countries in which there is a narrow gap between rich and poor have high life expectancy; they also have better educational attainment, social mobility and trust, lower crime and a fairer society as a whole. I appreciate that I have gone over time and apologise for that.

It is a pleasure to serve under your chairship, Mr Twigg. I will keep my remarks as brief as possible. I am grateful to my hon. Friend the Member for Bootle (Peter Dowd) for securing this important debate, at a time when the NHS is under enormous strain and facing a clear and present threat of relentless cuts and privatisation under this Conservative Government.

As well as leaving our beloved health service on its knees and struggling to cope after two years of a crippling pandemic, this Government have presided over a period of austerity that has seen health inequality become even more prevalent and extreme.

Last week, the other place started its Committee stage of the Health and Care Bill and began discussing proposed amendments about health inequality. Speaking at that Committee sitting, peers from across the House made clear that the Bill is a huge opportunity to eliminate health inequality and for the Government to demonstrate their commitment to tackling the “disease of disparity”, to quote the Secretary of State for Health and Social Care, who pledged to address the issue when he took office last year. However, in the months since, there has been little evidence that the Government are taking the bold steps required to address the crisis.

The Government cannot say that they are not aware of the issue, because research published in 2019 by the Department for Work and Pensions revealed that the highest reported rates of poor health in those under the age of 55 was overwhelmingly in the poorest percentiles, with the bottom 20% of the population having worse health outcomes by a staggering 1,100%.

Three years and a pandemic later, the situation is even bleaker. In 2020, life expectancy in England fell more dramatically than at any other point since world war two, as a result of the covid pandemic. In the poorest areas, life expectancy declined nearly twice as much as it did in the wealthy ones, while ethnic minority people died from covid at much higher rates. Sadly, those with disabilities faced a significantly higher death rate.

In my constituency, the gap in mortality and reported serious illness is stark. In the most affluent areas such as Heaton Mersey, life expectancy for women is 84 years, while for men it is almost 83. However, just a short distance away in central Stockport, the average life expectancy for a man is a staggering 12 years shorter, while in Brinnington a woman’s life will, on average, end a decade sooner. For life-threatening illnesses such as cancer and heart disease, it is a similar picture. On average, the limited life chances of my constituents are particularly acute. Research by the King’s Fund reveals that the north-west experienced a far higher proportion of deaths from covid-19 than the south-west, to give just one example.

Significant investment in our NHS is needed to halt the rise in health inequality. That includes hospitals, which unsurprisingly play a significant role in health outcomes for many people. That investment could be put towards the facility’s funding or its catchment area, or it could improve accessibility for the vulnerable. With the NHS already at breaking point following 12 years of Conservative Government austerity and a crippling pandemic, we cannot afford to be wasteful—a point I have made consistently since my maiden speech, when I criticised this Government’s underfunding of Stockport NHS trust by £170 million in recent years.

Ultimately, I welcome any decision that improves public health outcomes and ensures the best quality healthcare for the people of Stockport. To build a healthier, happier and more equal society we must do more than simply increase NHS funding. I therefore urge the Minister to give a genuine commitment to truly universal healthcare that is fit for purpose for everyone, enabling the NHS to continue to be the envy of the world.

It is an honour to serve under your chairmanship, Mr Twigg. I congratulate my hon. Friend the Member for Bootle (Peter Dowd) on an excellent, well-researched speech and on securing this important debate.

Before turning to the exact subject of the debate, as vice-chair of the all-party parliamentary group for vaping, I want to reflect on the role of the predecessor body of the Office for Health Improvement and Disparities. Public Health England sought to be a practical institution, with evidence and pragmatism at the heart of its approach to public life. I want to pay particular attention to its work on tobacco harm reduction, which I have witnessed not only as a member of the APPG but personally. Since 2015, across seven evidence reviews, PHE reports on the role that e-cigarettes can play in a healthier society have captured the ethos of the organisation in its entirety.

The first report was a landmark publication for the vaping industry. It concluded—I hope that everyone in this House heeds this fact when reflecting on reducing inequalities born from smoking cigarettes—that vaping is “95% less harmful” than tobacco. In its report, PHE went on to look favourably on e-cigarettes, while others have sought only to fuel misinformation, risking lives by claiming vaping and smoking to be one and the same. They are not. It is because of that evidence-based endorsement of vaping that millions of smokers across England and—dare I say it?—across the world, who have exhausted all other routes trying to quit smoking, have a fighting chance with an incredibly successful product that is helping smokers to quit.

Smoking is perhaps one of the biggest contributors to inequality in our society, causing considerable damage to private and public health, and it has a high impact on physical and mental health. It is an expensive and addictive habit, particularly for those most disadvantaged in our society, where smoking prevalence is highest. Vaping is less expensive and is an effective way to stop smoking. It is therefore critical that the Office for Health Improvement and Disparities recognises the role of vaping, picks up the torch left by Public Health England and continues to be a stalwart champion of tobacco harm reduction.

This could not be more important as we continue to wait for the Department of Health and Social Care to publish, first, its review of the Tobacco and Related Products Regulations 2016—that review is now eight months late—and secondly, its new tobacco control plan, which is also late and nowhere to be seen. The APPG for vaping’s door is always open to the Minister, and I know that leading bodies such as the UK Vaping Industry Association would welcome the chance to work with Government to secure a future in which the health benefits of switching from smoking to vaping are fully realised. The UKVIA has industry-led solutions to many of the remaining concerns that prevent people from finally making the switch to vaping. Those solutions include the guidance it produced on introducing restrictions on packaging and branding. I support that paper, and can share it with the Minister if she wishes.

The UK is seen by many across the world as a world leader in tobacco harm reduction, with countries, smokers and vapers looking to the UK for guidance in this space. That reputation should not be compromised by the loss of institutional knowledge during the transfer of resource from Public Health England to OHID, and it should not come at the cost of a Government Department delaying publications once again. If the Government are serious about levelling up and wish to support endeavours to improve people’s lives, they must ensure that OHID adopts the same evidence-based approach as its predecessor to finding solutions for life-debilitating problems.

I once again express my gratitude to my hon. Friend the Member for Bootle for having secured this debate. I hope that in responding, the Minister can provide clarity about the timeline for responding to the TRPR review and for the publication of the new tobacco control plan. I also hope that she agrees that the OHID must remain independent, with its institutional knowledge protected.

It is a pleasure to serve under your chairmanship, Mr Twigg. I thank my hon. Friend the Member for Bootle (Peter Dowd) for having secured this important debate, and for his eloquent and detailed speech. Salford is currently the 18th most deprived local authority area out of 317 in England, yet it is a tale of two cities: more than 30% of the city’s population reside in a highly deprived area, yet we are also home to some of the wealthiest suburbs in Greater Manchester. That disparity is shown starkly by our life expectancy. It has been improving over the past few decades, but there remains a gap between Salford and the rest of England of three years for males and two years for females.

Male residents living in the most affluent areas of Salford can expect to live more than 11 years longer than those in the most deprived areas, while females in the most affluent areas can expect to live seven years longer. I think we can all agree that that is morally wrong. Sadly, we have known for decades—from the Beveridge report to the Marmot report—that poor health, discrimination, housing, employment and income are inextricably linked, yet we have seen very little action in recent years. Of course, there was a burst of radical policy development in the late 1940s, with the creation of the welfare state and the NHS, for example, and we saw policy approaches in the late 1990s and early 2000s, but since then we have lacked a comprehensive health inequality strategy. What is worse is that austerity has resulted in the unravelling of many of the positive policies put in place and the undermining of the remaining ones.

The creation in October 2021 of the new Office for Health Improvement and Disparities and the announcement of a new cross-Government agenda to track the wider determinants of health and to reduce disparities were met with cautious optimism. However, since the creation of the OHID, there has been little information on what it will actually do or what it has done so far. Will the Minister clearly set out how the Office for Health Improvement and Disparities will reduce health inequalities? Indeed, what is the new cross-Government agenda? Can she confirm that the Health Promotion Taskforce will be given a remit to act outside of the Department of Health and Social Care, to address the true socioeconomic causes of poor health? Finally, can she set out how OHID will work with the new integrated care systems, and how it will support them to address health inequalities in their area?

As the Inequalities in Health Alliance states:

“If we are to prevent ill health in the first place, we need to take action on issues such as poor housing, food quality, communities and place, employment, racism and discrimination, transport and air pollution. All parts of government and public services need to adopt reducing health inequality as a priority.”

Of course, I fear that the Government will not do that. It would show that an active state that supports communities, industry and workers to increase living standards for all within a new, democratic economy is the only way to do this properly, and that goes against everything the Government believe in. None the less, I hope that the Minister will at least address some of the questions I have asked today.

It is a pleasure to serve under your chairship, Mr Twigg. I congratulate my hon. Friend the Member for Bootle (Peter Dowd) on securing this particularly important debate.

The Minister will be aware of the Tudor Hart law: the areas with the best health are more likely to receive better health services. As my late mum—a lifelong nurse—would have said, “Much gets more.” There can be few greater examples of that than in south-west London, where an imminent planning application proposes to open a new hospital in healthy, wealthy Belmont, but at a cost: the downgrading, in the heart of a pandemic, of both Epsom and St Helier Hospitals. In the wild west of south London’s NHS, it is almost as if coronavirus never happened. Under those reckless plans, St Helier will lose its A&E, intensive care, children’s unit, maternity services, renal services and 62% of its beds to a wealthier area of considerably better health—so much for levelling up.

We have seen this plan on repeat. Funding is allocated and everyone pretends that three possible sites are being considered for development: Epsom, St Helier or Belmont. Evidence of widening health inequalities is presented by the bucketload, but a reason is always found to choose Belmont as the winning site. The reality is that, at the time of the latest decision, there were more than twice as many people with bad or very bad health within a mile of St Helier than within a mile of Belmont. The local population is significantly larger, with considerably more dependent children and elderly people. It is a plan that flies in the face of any supposed commitment to tackling health inequalities.

The programme points to its deprivation analysis—a document that considered deprivation by borough, rather than by proximity to each of the possible sites. Why does that matter? It matters because it disguises huge inequalities within boroughs, such as the 10-year difference in life expectancy between parts of Merton.

The true analysis of deprivation could not be clearer. Some 42 of the 51 most deprived areas in the catchment are nearest St Helier. Given that, hon. Members can surely see how ridiculous it is that the Belmont site received a higher score for supposedly tackling deprivation. Is it any wonder that health inequalities keep widening? While the programme considered old age as a decisive factor in the location of acute services, the depressing reality is that old age in Mitcham looks very different from old age in Belmont.

Health inequalities in south London are stark, and not just by geography. Black, Asian and minority ethnic residents are more likely to have underlying conditions such as diabetes, lupus and kidney failure and are at a higher risk of developing heart disease and hypertension. Black women are five times more likely to die in childbirth than white women, and are more likely to require neonatal or specialist care baby units. Such facts are of paramount importance for this hospital reconfiguration, as 64 of the 66 areas across the catchment with the highest proportion of BAME residents are nearest St Helier. Just one is nearest Belmont. Under those plans, many women will see maternity services moved further away. The programme’s solution is to encourage more women to have a home birth, which is obviously dependent on the risk to mum and baby and is currently chosen by just 3% of women in the catchment area.

The reality is that my constituents will not travel to Belmont. It is quicker from every corner of Mitcham and Morden to reach St George’s Hospital or Croydon. That is a completely terrifying prospect, because St George’s is already coping with too many women having children there, its A&E is in the bottom quartile for space standards, and the Care Quality Commission has demanded that fewer patients attend the site.

Where does this leave us? The planning application for the Belmont site is imminent, and the cost of the proposals is soaring—the latest estimate is almost £600 million. Improving St Helier would not only keep services where they are needed most, but save £161 million. I ask the Minister to take the unequivocal evidence that I have presented and, if she genuinely wants to close health inequalities under her watch, insist that these proposals are reconsidered. Stop wasting taxpayer’s money and leave these vital services at St Helier’s current site.

It is a pleasure to serve under your chairmanship, Mr Twigg. I congratulate my hon. Friend the Member for Bootle (Peter Dowd) on his excellent speech and on securing this important debate. As we know, the Office for Health Improvement and Disparities was officially launched in October as part of a wider Government restructuring of public health bodies in England. Back in September, the Health Secretary announced his vision for what the OHID would prioritise. He listed three goals: preventing poor mental and physical health; addressing health inequalities and improving access to health services; and working with partners within and outside of Government to respond to wider health determinates.

It is welcome that the Government have set out to alleviate health inequality. However, in order to truly tackle the disparities in health outcomes, the Government must change course and more closely consider the health outcomes for illnesses associated with stigma, misunderstanding or insufficient public awareness. I am speaking specifically about those living with HIV in this country. Despite accounting for less than 2% of the British population, people of black African heritage accounted for 13% of new HIV diagnoses among heterosexuals in 2020, and 64% of these diagnoses were of women. People of black African heritage are also significantly impacted by late HIV diagnosis, which is particularly frustrating, considering that those who are diagnosed late are much more likely to die from the disease.

I am increasingly concerned by the state of HIV testing in this country, given that the proportion of people who are eligible for a test but are not offered one more than doubled in 2020. That is completely unacceptable, and it is a systemic problem that falls under the remit of the OHID. I want to use this debate to urge the OHID to monitor the provision of commissioned services for people who are disproportionately likely to be diagnosed with HIV, and to consider how they could be improved. In particular, I want it to look closely at the availability of testing, both at home and in A&E departments, especially in areas of high HIV prevalence, and to consider the extent to which that might be acting as a barrier to achieving its aim of ending HIV transmission by 2030.

If the Government truly want the OHID to tackle health inequalities, then its work needs to have a laser-like focus on improving health outcomes for those living with stigmatised illnesses, such as HIV. It goes without saying that the Government cannot fulfil their pledge to end HIV transmission by 2030 without taking the measures that I have outlined today.

It is a pleasure to serve under your chairmanship, Mr Twigg. I thank the hon. Member for Bootle (Peter Dowd) for setting the scene. He is a man known for setting the scene well, and we appreciate his contribution—I think every one of us will have been heartened by what he has said today. I wish to make a contribution as my party’s health spokesperson. I am pleased to be here to discuss the evident disparities and inequalities in our health system, both on the mainland and back home in Northern Ireland. I know the Minister is not responsible for health in Northern Ireland, but I will give examples that will hopefully spur those who speak in this debate.

We must ensure that everyone has access to efficient healthcare. I will speak about three groups of people: those with mental health issues, those who are homeless and those with addictions. The Office for Health Improvement and Disparities officially launched in October 2021, as part of a restructuring of health bodies in England and throughout the UK. I am pleased that the OHID will co-ordinate local and central Government to initiate improvements in public health. The purpose of the OHID is clear. If it delivers on that purpose, everyone present will be more than pleased because many of the issues would be addressed.

I thank the Government for listening and learning from the lessons of the pandemic, and that information has now been taken ultimately to improve our health service. The Minister has said that our Government have three priorities to work on. The first priority is preventing poor mental and physical health. One in four people in the UK—25% of the population—and 19% of adults in Northern Ireland suffer from poor mental health, so that should be prioritised. The second priority is addressing health inequalities. Health is devolved, but this must be a priority for the Department across the whole of the United Kingdom. The third priority is working with partners within and outside Government to respond to the wider health determinants. These partners also have a responsibility for public health outside England.

I will talk about addiction issues and why it is so important that we address them within this campaign and policy, which the Minister will reply to shortly. In Northern Ireland, and in my constituency in particular, alcohol and drug-related indicators continue to show some of the largest health inequalities monitored in Northern Ireland, with rates in the most deprived areas five times those of the least deprived areas for drug-related mortality, and four times those for alcohol-related mortality. I suspect that other hon. Members will also state those mortality figures for people with drug or alcohol addiction issues. The inequality seems to be, unfortunately, in the areas where people have a poor quality of surroundings and less money, and therefore they are the ones we need to focus on because of the high risk of mortality that is prominent.

The King’s Fund has ascertained that health inequalities are avoidable and depend on people’s access to care; the quality and experience of care; behavioural risks to health, such as smoking and drinking; and wider determinants of health, such as housing circumstances and social factors and decisions. All these things combine to put pressure on people. Crisis, an organisation that campaigns to end homelessness, has contacted me in relation to tackling the disease of disparity. That is quite a term: the disease of disparity. Yes, it is a disease and it needs to be addressed. People who are homeless face some of the poorest health outcomes in society.

Some of the statistics are as follows. People experiencing homelessness are three times more likely to be diagnosed with a severe respiratory health issue. I did not know that until I got that information from Crisis, but it is a fact. The average age of death among homeless people is 46 for men and 42 for women, as the hon. Member for Stockport (Navendu Mishra) referred to. In this day and age that is totally unacceptable. We must address that issue. At the same time, I read in the papers—I do not know whether it is true—that people are living longer. Will someone who is homeless live longer? They will not, and therefore that must be addressed. I hope the Minister can respond to that.

Finally, a recent study found that people facing homelessness in major cities, such as Belfast or London, have levels of frailty like that of a 90-year-old. Again, that is another combination of issues. The barriers blocking greater equality for our health service are just astonishing, and these have only been exacerbated by the pandemic. It is about time that we started prioritising, and that starts with everyone being given the same allowances to access our truly admirable NHS.

Lastly, it is time for the OHID to monitor the provision of commissioned services for those who are socially disadvantaged and cannot access sustainable healthcare. I urge the Minister to commit to producing guidance and support on what actually works in the provision of health and social care services. I believe our duty in this House is to speak up for those who need speaking up for. Today, I am doing just that.

It is a pleasure to serve under your chairmanship, Mr Twigg. I congratulate my hon. Friend the Member for Bootle (Peter Dowd) on securing this important debate. When the Government launched the Office for Health Improvement and Disparities, renamed from the Office for Health Promotion, the Secretary of State said that it was not just a name change but

“a statement of intent—a driving mission to ‘level up’ health and ensure everyone has the chance to live happy and healthy lives.”

That is a mission that I sincerely hope all his Cabinet colleagues will commit to truly delivering on. The issue goes to the heart of the inequalities in communities such as mine. Sadly, it is an issue that has only got worse over the last decade. In the Government’s most recent national deprivation data, Barnsley ranked in the bottom 15% of the country for levels of income. Of the 318 local authority areas in the entire country, Barnsley ranked as the 19th worst for health deprivation and disability.

The Secretary of State has said that the top two priorities for the new office are preventing poor mental and physical health and improving access to health services, as has been discussed in today’s debate. As things stand, Barnsley is well above the national average for diagnoses of depression, arterial disease, learning disabilities, high blood pressure, heart failure, epilepsy, diabetes, dementia, obesity and heart disease. Barnsley East residents are almost twice as likely as residents anywhere else in the country to suffer from chronic obstructive pulmonary disease, much as a result of the thousands of men who worked down the pit. Around 8,000 miners have sadly lost their lives over the last two years.

I have raised the issue of covid death certificates with the Government on several occasions. I directly ask the Minister, again, whether she can give us an update on what the Government are doing to change guidance—it is a very simple ask—to ensure that industrial diseases are recorded on death certificates if someone, sadly, dies of covid. That is important to make sure that families receive the compensation to which they are entitled.

We cannot look at health inequalities in isolation, because income and health inequality are fundamentally linked. The ONS reports that the difference in life expectancy between the least and most deprived areas in England is 9.4 years for men and 7.6 years for women. The difference in the number of years lived in good health between the most and least deprived areas can be as much as 20. While areas such as Kensington and Westminster thrive, northern working-class towns such as Barnsley continue to be left behind.

There can be no justification for the levels of inequality that we face. Whether someone lives in Westminster or Barnsley, they deserve to live well. We have a long way to go if we are to tackle these health inequalities. They are not only an enormous challenge that the Government need to address today; they mean reversing more than a decade of decline.

It is an honour to serve under your chairmanship, Mr Twigg. I congratulate the hon. Member for Bootle (Peter Dowd) on securing the debate and making an excellent opening speech. I also endorse what has been said by hon. Members on all sides—predominantly those from urban areas, because poverty is a major driver of health inequalities and discrepancies. I hope that my colleagues will understand if I now focus on some rural discrepancies, which are also significant and in some ways overlap with those on which hon. Members have focused so far.

The first area I will look at is social care. Social care is, obviously a huge issue and under massive pressure everywhere in the United Kingdom. There is an extra problem in rural communities like Cumbria. In my constituency, the average house price is 11 times the average household income; there are twice as many second homes in my patch as there are council houses. At this moment, 150 people who should be in social care are stranded in hospital beds, and one of the reasons for that is that the Government underfund social care. Not a penny of the national insurance rise that is coming will go into the pockets of hard-working care workers, so it is hard to retain and recruit them from a relatively small working-age workforce.

That has led to a number of issues. Just the other day, I was speaking to a person who needs a rota of six carers in order to function, but that person has not been able to find more than three for the last six to nine months. That is caused by a number of things, including silly visa rules, which the Government need to look at again, and the massive discrepancy between house prices and income—the availability of anywhere affordable to live for folks in the area.

Secondly, there is the issue of mental health—particularly young people’s mental health. Similar issues are present there when it comes to recruiting and retaining staff. There are wonderful staff—too few of them. When I did a survey of families in my constituency last year, we discovered that more than 50% of young people who presented with mental health conditions that needed attention waited more than three months, and 28% waited more than six months. Some 52% said their experience of that care was poor as a consequence.

If a 15-year-old broke their leg on a football field on a Sunday afternoon, they would be seen immediately, but if something invisible breaks within one of our young people, they wait six months or more. That is intolerable anywhere, but it is fuelled by the fact that we are in a rural area that is underfunded for mental health provision.

When it comes to GPs, a few years ago the Government got rid of the minimum practice income guarantee, which subsidised small surgeries. Small surgeries in rural areas are not small because they are bad, but because they cover the size of a small country but a relatively small population. Coniston, which mourns its doctor, Dr Simon Fisher, who sadly passed away just a few weeks ago, has a roll of just 900 patients, not because its practice is poor quality but because it covers a vast area. The Government took away that money.

The sticking-plaster money, called atypical practice funding, that went to some surgeries just to keep them going will fold when the clinical commissioning groups go and the new integrated care boards come in, in just a few months’ time. I ask the Minister to look carefully at that, as otherwise we may lose dozens, if not hundreds, of rural GP surgeries around the country.

On cancer provision, the National Radiotherapy Advisory Group states that it is bad practice for any patient needing radiotherapy to have to travel for more than 45 minutes for treatment. I can tell the Minister that not a single person in my constituency lives within 45 minutes of radiotherapy, and many of them must make four-hour round trips, day after day, in order to get treatment at an excellent but distant centre in Preston. If the Minister is committed to tackling discrepancies, she will finally do what Government after Government, including the one of which I was part, have failed to do—deliver the satellite radiotherapy unit at Kendal that we have long been campaigning for. That will shorten those journeys and save lives.

My final point is about accident and emergency. The nearest accident and emergency centre to most of my constituency is at Lancaster. There is a lot wrong with the hospital at Lancaster. It is an old site, at the wrong end of the one-way system, and could do with renewing. Talk of hospital improvement money going into it is welcome, but what is not welcome is the Minister’s Government’s continued insistence on looking at the option to close the Royal Lancaster Infirmary, merge it with the hospital at Preston and have a new hospital somewhere in the middle. If the answer is to make A&E for south Cumbria another 10 or 15 miles further away, that is the wrong answer. I ask the Minister to talk to the Secretary of State for Health and Social Care and others to take that option off the table, so that people from my communities do not have to travel dangerous distances to get the treatment they deserve.

I endorse what my colleagues from more urban areas said earlier in the debate, but I want the Minister to focus on the fact that many people in rural communities think they are overlooked by this Government, that their votes are taken for granted, and that as a result we get the situation that I have just outlined.

It is a pleasure to serve under your chairmanship, Mr Twigg. I add my congratulations to my hon. Friend the Member for Bootle (Peter Dowd) on securing this debate and on the passionate way that he opened it.

Health inequalities are one of the defining issues of our time and are innately linked not only to how long we live, but to how well we live. Every person across this great country deserves to thrive and live a long, fulfilling and healthy life. That principle informed the creation of our national health service and it continues to drive the work that Opposition Members do.

As colleagues have done, I reinforce to the Minister the perilous position that we find ourselves in with regard to health inequalities. The pandemic has exacerbated the health inequalities that were already widening prior to the first lockdown. Indeed, in February 2020 the King’s Fund reported:

“Males living in the least deprived areas can, at birth, expect to live 9.4 years longer than males in the most deprived areas.”

For females, as we have heard, this gap is 7.4 years. That is not good enough.

Worse, the gap is increasing. Life expectancy has had a steady ascent for 100 years. That ascent began to plateau in 2011. Can the Minister advise what she thinks happened in 2010 that led to that abrupt stalling of life expectancy? It is very real. [Interruption.]

Sitting suspended for Divisions in the House.

On resuming

Before I was interrupted by the Division bell, I was about to say that I have seen at first hand the injustice of health inequality. Denton, the main town in my constituency, where I grew up and have lived, is not a very large town. It has a population of 38,000 people spread over three council wards, and its area is 2.5 miles by 1.5 miles. I grew up in Denton West, which is one of the more prosperous wards in my constituency and in the borough of Tameside.

My best friend at secondary school lived in Denton South, which, conversely, is one of the poorest. We both went to the same school. We were two kids growing up in the same community, at the same school, doing the same things, hanging around together. Yet according to the average life expectancies, he will live 10 years less than I will. That cannot be acceptable, it is not acceptable, and it is one of the reasons I joined the Labour party and became politically active. Tackling those inequalities, not just in a small community such as Denton but across the country, is absolutely what we should be about, in order to improve outcomes for all.

The last decade has been a disaster in terms of inequality, and I say to the Minister that that is the direct consequence of political choices that her party has made. It is a consequence of a decline in real-terms local authority spending, a consequence of a reduction in per-person education spending—a consequence of 12 years of Conservative government. The fact is that it is impossible to corral health inequality into one box. As we have heard in this debate, it is closely tied to social determinants: where people grow up, their environment, their education and their disposable income all contribute to health inequalities. If we are to tackle the crisis, the Government must recognise that they cannot make policy decisions in a vacuum.

That leads me to the issue of the Office for Health Improvement and Disparities. I note that one of OHID’s key priorities is to

“develop strong partnerships across government, communities, industry and employers, to act on the wider factors that contribute to people’s health, such as work, housing and education”.

That is music to my ears. It is clearly a positive and welcome aspiration, but three months on from OHID’s launch, we have yet to see any clear indication that cross-Department work has actually been prioritised by the Government. This point has been made by the Inequalities in Health Alliance, an organisation with more than 200 members, including the Royal College of Physicians. The IHA has asked the Government to underpin and strengthen OHID’s work with an explicit cross-Government strategy to reduce health inequalities, involving all Departments, and led by and accountable to the Prime Minister. So far, the Government have been resistant to committing to that.

I would be grateful if the Minister, in her response, could advise us what assessment she has made of the request from the IHA and whether her Department will commit to developing a specific cross-Government strategy. In addition, can she set out how OHID will assess its own effectiveness, and what influence it will have on other Departments? Will she also outline what engagement OHID has had with other Departments since it was established back in October? We need to know that OHID is not just more warm words with very little in the way of positive action. The Government cannot point to OHID with one hand and then, with the other, undermine the work that it purports to do.

For example, last October, the very month in which OHID was formed, the Chancellor of the Exchequer ended the £20-a-week uplift to universal credit. That plunged 300,000 children into poverty pretty much overnight. That political decision obviously has a negative public health impact for people across the country, yet apparently that was not something the Chancellor either considered or seemed particularly concerned about at the time. Can the Minister advise us how OHID will prevent further such disastrous policies from being implemented? If she cannot, I simply do not see how it will solve the crisis of health inequality in this country. I would be grateful, too, if she could outline what role OHID will play with regard to the new integrated care systems. Some clarity on that would be very much appreciated, particularly in advance of the Health and Care Bill’s anticipated return to the Commons in the next few weeks.

Finally, I want to touch on the subject of levelling up and its relationship to health inequalities. It has become somewhat of a go-to phrase for the Government. It should perhaps be a cause of concern to the Minister that, more than two years into this Administration, the levelling-up White Paper still has not been published. On that note, I want to press her on what exactly the Government’s priorities are.

In 2020, Professor Sir Michael Marmot published “Build Back Fairer” in Greater Manchester, which called for several policy interventions from the Government. Professor Marmot proposed investment in jobs, housing, education and services, and made particular reference to tackling the social conditions that cause inequalities at local and community level. We saw local authority public health funding cut by 24% per capita in real terms between 2015-16 and 2020-21. That is the equivalent of a reduction of £1 billion, which cannot be right. We need to restore public health funding to local authorities, so that local teams are able to provide vital services that communities need to stay healthy.

In conclusion, we went into the pandemic with health inequalities already growing, which left Britain’s poorest areas, as well as those in black, Asian and minority ethnic communities, acutely vulnerable to covid-19. That is totally unacceptable. We are now in 2022; we should not be living in a society with such extreme levels of health inequality. It is not right, and it needs fixing. The Government must do more and can do more, and they must do better.

The debate will finish no later than 4.25 pm. I know that the Minister is aware of the need to allow two or three minutes at the end for the hon. Member for Bootle (Peter Dowd) to wind up.

It is a pleasure to serve under your chairmanship, Mr Twigg. I congratulate the hon. Member for Bootle (Peter Dowd) on bringing forward this extremely important debate. It has been really interesting and, with many people contributing, it has been quite rounded. The hon. Gentleman spoke passionately and knowledgeably about the issue, as did other Members. We have probably done the issue a disservice by having only an hour and a half to debate it. I look forward to further debates.

It is time to shift the centre of gravity of the health system from treating disease to building good health. To do that, we have to focus on the people and places who face the worst health outcomes. That is why on 1 October 2021, we launched the Office for Health Improvement and Disparities. The mission of OHID is to improve the health of our country so that everyone can expect to live longer in good health, and to break the link between people’s background and their prospects for a healthy life.

OHID is doing that by working with the rest of Government, the healthcare system, local government and industry, to bring together expert advice, analysis and evidence in policy development and implementation. As a number of hon. Members mentioned, covid has shone a light on the poor underlying health of certain groups in the population, the depth of health disparities and the implications for our health, economy and society.

Health disparities across the UK are stark. As the hon. Member for Bootle highlighted, in the borough of Sefton, where his constituency is located, the life expectancy deprivation gap is 11.8 years for women and 12.5 years for men. Health disparities can be driven by a range of factors, including education, income, employment and early years experiences. Therefore, OHID aims to systematically tackle the top preventable risk factors for poor health by looking actively at the evidence on health disparities and the ways in which we can go further to address them.

The new Health Promotion Taskforce, which was set up by the Prime Minister, will drive and support the whole of Government to go further in improving health and reducing disparities, because many of the factors most critical to good physical and mental health are the responsibility of partners beyond the health service. This new Cabinet Committee, now chaired by the Secretary of State for Health and Social Care, brings Departments together around the objective of reducing ill health and health disparities. It also provides a new opportunity to work together actively on the most important health issues and agree new ways to address them collectively. I hope that helps reassure colleagues that the new taskforce is at the top of Government, and is determined to bring all Departments together to tackle this agenda.

In my contribution, I referred to the contact that I have had with Crisis on homelessness. Will the contact that the Minister has referred to include those groups? They have the facts. She will have heard what I said about the disparities between those who, like us, live in a well-off area, and those who do not and have not got a home. Homelessness is deadly.

I reassure the hon. Gentleman that tackling homelessness is a high priority for this Government.

As hon. Members have mentioned, the Government will shortly publish a landmark levelling-up White Paper that will set out bold new policy interventions to improve livelihoods and opportunities in all parts of the UK, and to reduce the disparities between different parts of the UK. Poor health is stopping people accessing quality education and jobs with good career prospects, limiting their career progress, and undermining local prosperity and the general wellbeing of communities across the UK. Of course, it would be wrong of me to pre-announce the contents of that important White Paper.

Tackling health disparities promotes economic prosperity by increasing productivity and reducing strain on public services, including the economic cost of preventable ill health to the NHS and the welfare system. To address those issues, we are investing in tackling the key contributors, such as obesity and smoking. We are also investing £500 million to transform Start4Life and family health services.

I refer back to my point about not victim blaming, but in relation to the NHS resource allocation formula, can I ask the Minister whether the Government will be reinstating the health inequalities weighting that the previous Administration scrapped?

If I may, I will write to the hon. Lady on that so I can make sure that my facts are completely clear, rather than giving her an answer that may not be quite accurate.

In recognition of the strong relationship between work and health, the joint work and health unit was established in 2015. It has invested in a programme of trials and tests to identify effective models of health and employment support, and it is now using that learning to develop and/or roll out services to support disabled people and people with long-term health conditions to enter and stay in employment. The 2021 spending review confirmed that the public health grant will be maintained in real terms for the spending review period, so local councils can continue to invest in prevention and essential public health services. The distribution of that grant is heavily weighted towards the areas that face the greatest population health challenges, with per capita funding almost 2.5 times greater for the most deprived authorities than for the least deprived. The allocation at local authority level will be announced shortly.

The role that local authorities play in improving public health is far broader than simply the important services and interventions funded through the public health grant. That grant is part of a wider package of targeted investment in improving the public’s health over the spending review period, including £300 million to tackle obesity; £170 million to improve the “best start in life” offer available to families, including breastfeeding advice and parent-infant mental health support; and an additional £560 million to support improvements in the quality and capacity of drug and alcohol treatment, which was announced as part of the drugs strategy. In addition, we have made over £12 billion available to local councils since the start of the pandemic to address the costs and impacts of covid-19. Of this money, £6 billion was non-ringfenced, because we recognise that local authorities are best placed to decide how to manage the major covid-19 pressures in their local areas.

I made a point in my speech about an issue that affects my area, regarding covid death certificates and industrial disease. Would the Minister either respond to it now or write to me about it?

I was going to answer the hon. Lady’s point shortly, but I will answer it now. I will write to her on the important issue she raised about industrial disease. We need to ensure we have everything in place to enable families to access the different forms of support available to them.

I will come back to OHID for a moment. OHID has regional teams, which will have a vital role in working with integrated care systems at regional level. OHID will produce important data and information resources, which will be vital to ICS work in improving population health. Through ICSs, we will improve local working on population health and reduce health disparities.

One of the key objectives of these reforms is to give integrated care boards the responsibility and the ability to tackle health inequalities, as made clear in NHS England guidance. This will also reinforce the role of local authorities as champions of health in local communities and empower the NHS to improve poor health.

I will answer a few of the questions that have been asked. The hon. Member for North Tyneside (Mary Glindon) raised e-cigarettes. I commend her for the work that she does through the all-party parliamentary group for vaping, and I reassure her that OHID will continue to monitor and publish evidence and reviews on e-cigarettes. Our tobacco control plan will be published later this year, outlining our smokefree 2030 plans.

The hon. Member for Westmorland and Lonsdale (Tim Farron) highlighted disparities affecting rural communities. He raised a number of issues specific to his constituency, and I am sure that the relevant Health Minister will be happy to meet him to discuss them in more detail.

The hon. Members for Bootle and for Salford and Eccles (Rebecca Long Bailey) asked why we use the terms “disparities” and “inequalities”. I reassure them that the terms are used interchangeably, and it is important to understand that a term itself does not impact on our understanding of a problem or our response to it.

I thank the hon. Member for Bootle again for securing a debate on such an important issue. The pandemic has highlighted the impact of health disparities on people’s life outcomes and the pressures on the wider health and care system. The establishment of OHID, the creation of the new Health Promotion Taskforce Cabinet Committee and targeted investment in public health demonstrate that the Government are fully committed to tackling health disparities. I genuinely believe that by working together across Government, and with local authorities and the NHS, we can make a huge difference in improving health, life expectancy and life outcomes, particularly for the most vulnerable in our society.

I appreciate the fact that so many colleagues have come here to discuss this matter today, because it really goes to the heart of the needs of our communities.

We need a seismic shift—a paradigm shift—to tackle health inequalities and inequalities more generally. If we can guarantee £1.3 trillion to support a few institutions because of the banking crisis and £400 billion in relation to the pandemic, surely we can afford in the longer term to tackle health inequalities that affect the lives of millions of our constituents—many of whose lives are, to quote Thomas Hobbes’s “Leviathan”, “nasty, brutish, and short”.

Question put and agreed to.


That this House has considered the Office for Health Improvement and Disparities and health inequalities.