18:59 - The House divided: - Ayes: 181 / Noes: 319 - Question accordingly negatived.
The Parliamentary Under-Secretary of State for Health and Social Care (Jo Churchill)
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.
Geraint Davies (Swansea West) (Lab/Co-op)
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?
Jo Churchill
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).
Jo Churchill
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.
Dr Andrew Murrison (South West Wiltshire) (Con)
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.
Jo Churchill
I will come on to that point in a few minutes, if my right hon. Friend will bear with me.
Mr Perkins
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?
Jo Churchill
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.
Jo Churchill
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.
Debbie Abrahams (Oldham East and Saddleworth) (Lab)
Will the Minister give way?
Jo Churchill
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.
Debbie Abrahams
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?
Jo Churchill
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.
Jamie Stone (Caithness, Sutherland and Easter Ross) (LD)
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.
Jo Churchill
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.
Jonathan Ashworth
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?
Jo Churchill
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.
Jo Churchill
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.
The Parliamentary Under-Secretary of State for Health and Social Care (Ms Nadine Dorries)
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—
Mr Nicholas Brown (Newcastle upon Tyne East) (Lab)
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.