Covid-19 and Health Inequalities: West Yorkshire

Wednesday 21st April 2021 Westminster Hall

[Mr Philip Hollobone (in the Chair)]

I remind hon. Members that there have been some changes to normal practice in order to support the new hybrid proceedings. Members should clean their spaces before they use them and when they leave. Also, Mr Speaker has stated that masks should be worn when not speaking.

11:01

[Jon Trickett (Hemsworth) (Lab)]

I beg to move,

That this House has considered health inequalities and the covid-19 outbreak in West Yorkshire.

Thank you for calling me, Mr Hollobone. I thank everyone who has enabled me to secure this important debate so that a Yorkshire voice can make the case. I will be speaking about covid and the vaccine, so first I should like to place on record our thanks from every part of the House to everyone who helped to develop the vaccine, be they scientists, pharmacologists or all the people who have rolled it out. It has been an incredible journey, which shows humanity in a common endeavour against a disease. I congratulate all those involved.

I need not detain the House for long, but I will make a clear case for my constituency in West Yorkshire, where I have lived all my life, although there are lessons for the rest of the country, too. Let me raise two brief points before I get to the central issue. First, statistics. They talk about lies and statistics. I have confidence in the statistics that I will use, because I have been tracking what has been happening since January. They vary a bit, but I am sure that the trends I will describe are correct.

I will use comparisons between my area and the Minister’s area—not to suggest that somehow she has been neglectful of our area while protecting hers, but because the differences are extraordinary. Not for one second do I think she is anything other than someone who wants to do their best for the whole country. However, there are chronic underlying problems in the way that our country is organised. The Government have said they will begin to level up; hon. Members will see how far we have to go. If I were to draw a map of England—the health service that we are responsible for—and shade the economic-social demography, it would be clear that there continues to be a north-south divide. If I were to draw a map of covid, the same would apply. It is striking.

The averages conceal quite a bit; none the less, there has been a rapid decline in covid infections. The figures that I will quote are per 100,000. In January, there were 406 infections per 100,000; now, it is 28 per 100,000. That is remarkable.

[Mr Philip Hollobone (in the Chair)]

I am really interested in what the hon. Gentleman is saying. Are the figures that he just gave for West Yorkshire?

[Jon Trickett]

The figures were for the UK as a whole. It has gone from 406 in January to 28 now. We often hear that no one is safe unless everybody is safe. There are clear hotspots where the infection is still raging, while in other areas it has almost been eliminated. To make the areas that are already low safe, we have to tackle the hotspots.

The UK average is now 28 infections per 100,000, but in my council area it is three times higher, at 72 per 100,000. In West Suffolk, infections are 8.4 per 100,000. Infections are nine times higher in my area of Wakefield than in the Minister’s constituency. That is a staggering difference.

I represent 23 small former mining villages in my constituency. In one ward, the figure is five times higher than the English average, but 17 times higher than the figure for the Minister’s constituency. It is staggering. Across the whole of West Yorkshire, there are 20 areas with levels of ongoing infection that are at least 12 times higher than those in her area. Mine is not even the highest in West Yorkshire. The figures are stark.

Plotting a graph—clearly I cannot illustrate it here, although I would like to—shows that the rate of infection in my constituency was around the English average back at the beginning of January. Suddenly, the line on the graph takes off relative to the national average. That was within three or four days of the decision that was taken—by scientists, I presume, but with the support of the Government—to reduce the vaccine supply to Yorkshire. They halved the amount of vaccine coming into Yorkshire. The average rate in England has continued on its way, whereas the rate across Yorkshire has accelerated rapidly. On the other hand, Wakefield—my area—is vaccinating more than the Minister’s council is. I assume that it was a short-term reduction in supply of the vaccine, rather than something that is continuing through to this day, but perhaps the Minister could confirm that.

There are four underlying factors. I want to focus on one at the end of my speech, but why is it that some areas of the country have alarming hotspots, such as the ones in my area that I mentioned? The four factors all relate to socioeconomic class, stratification or however one wants to describe it. The first is deprivation. Covid is definitely a disease that feeds off poverty in deprived areas. My constituency is the 111th most deprived; the Minister’s constituency is the 417th. Added to that is the fact that I represent former mining communities, where many older men have serious respiratory problems, which obviously makes them vulnerable to a respiratory disease.

The second factor is the cuts that have happened. About 38% of our expenditure has been cut since 2010, which leaves our communities less resilient to all kinds of things, including covid, than they would otherwise be.

The third factor that I want to briefly highlight is the reduction in the number of bed spaces. There has been a kind of consensus that there were too many beds. I never agreed with that; I fought the cuts in the hospitals in my area, unsuccessfully. Some 21,000 beds—I think I am right in saying critical care beds—have closed since 2010, which is too many. We were not ready for the pandemic.

I will discuss the fourth factor before I come to the main issue that I want to raise. We have low access to car ownership in my community, and more than a quarter of households do not have access to a car. As I have already said, I represent a series of villages. The buses are not very good and there is not a frequent service—I am sure thata many hon. Members could say the same thing about their areas. It is very hard for someone to get to hospital if they do not have a car and the bus service is rubbish.

There is a problem not simply with the aggregate number of beds throughout the country, but in connection with population sparsity. I wonder whether more work has been done on this issue. I do not necessarily expect the Minister to reply to me now, but has the relationship between sparsity and access to hospital services ever been properly considered? It was in my area, because I made sure that the people who were making the decisions fully understood the implications of closing hospitals and reducing the number of beds. There are 10,300 households with no car in my constituency alone, which is a problem.

My final point, in terms of what is causing not only our area but West Yorkshire to be a hotspot, is to do with homeworking. Anyone looking at the data will see how striking it is that the proportion of the population who are homeworking varies considerably across the country. For example, in Yorkshire just over a third of people are working from home; two thirds are still working at their place of work. That compares with nearly 60% of people working from home in London. In the Minister’s region, there are 10% more people working from home than in Yorkshire.

As might be imagined, seven out of 10 people in professional occupations are now working from home, whereas in caring, leisure and other services it is only 15% and among process plant machine operatives it is only 5%. So, 5% compared with 70% shows that there is a stratification issue. Why is that relevant? Because people who are working from home are clearly less prone or susceptible to possible disease transmission at a place of work. As their place of work is their home, they are in their domestic bubble.

It is striking that homeworking or working in the workplace relates precisely to occupational structure and the character of the local economy. With an economy such as the one that we have in my area, lots of people work in small manufacturing, warehousing, care services, retailing and other forms of services. We could say that they are all key workers in one form or another because they have kept the country going, but they are working in the workplace rather than at home, so they are exposed to the possibility of workplace transmission.

I have given a lot of figures already, but it is good to get them on the record. Yorkshire has 9% of the English population, but 36% of all workplace transmissions for the whole of the country occurred there. So, it is clear that workplace transmission, reflecting the occupational structure and economic base, is a factor. So, more than a third of all workplace transmissions were in Yorkshire alone, which is an important point.

There is a second related issue, which is access to cars. If someone lives in a village and their place of work is, say, a large warehouse near the A1, then they have to get to work. There are no buses or trains, so what do they do? They share a vehicle, either a minibus or a car, with someone else who lives in the village. The possibility of transmission related to work is clear.

Another point is about the vaccine roll-out. Rightly, the vaccine roll-out tackled the oldest and most vulnerable people first. We are only now arriving at vaccinating the under-50s, but they are the people who are often working in the workplace rather than at home. The vaccine has not reached many of the people who are working in the workplace and who are obviously the most vulnerable to workplace transmission. I would not suggest that we should have done anything differently, but the Government, and we as a country, need to think clearly about the issue of workplace transmission of the virus.

I have one further point on this matter. Some people might say that we should lock down the hotspots, but that will not work. Why do I say that? Because a lockdown affects people who are not key workers. People who work in key industries, such as retailing, care or warehousing, if they are delivering important services or commodities, are still going to work. A lockdown does not protect the people who are at work, and therefore it does not prevent workplace transmission. That seems to be quite an issue for us. Again, I am not saying that the Government were wrong to do the regional lockdowns—we could clearly see that those had an effect—but at the end of the day, they abandoned them. I do not want anyone to listen to my points and say to themselves, “Well, actually there’s a bit of a problem in Yorkshire. We need to protect other parts of the country; let’s lock down Yorkshire.”

If I am right—I would be interested to know whether the Government have other statistics on this—workplace transmission is a serious issue. I spoke about that with the local GP in the most seriously affected village in my constituency, and he thought that it is now about workplaces, and car and minibus sharing. I spoke to the director of public health, who told me broadly the same thing. She said that the figures are slightly susceptible to small variations at ward level, but she still defended them. I then spoke to the chief executive of our health trust. Obviously, he was most concerned about the number of hospital admissions; although that number is now going down because of the medical treatment that we have developed, the ratio is still far too high in our area. He also thought that workplace transmission was an issue.

What do I think ought to happen? Well, the Government may well have already formed a view about workplace transmission. I read in this morning’s newspaper, which covered some of the issues that I am trying to raise, that the Government had responded by saying, “We’ve made available to employers the possibility for an enhanced test, trace and isolate service.” Although I welcome that, because there needs to be as much emphasis as possible on trying to find out who is infected and ensuring that they isolate, there are two problems. First, some people are on very low wages and will not necessarily volunteer that they have symptoms because they are worried about the financial impact on themselves and their households. Secondly, employers are variable, just like any other part of the population. Some employers are very careful, others less so.

I have been approached by a firm, which I will not name, that has a large warehouse in my constituency. It is a household name that provides goods on the high street—everybody knows the name. The workforce, most of whom live in my area, have repeatedly raised with us a sense of not feeling safe at work. I asked the council to visit the employer, and work has been done to make the warehouse a safer place and to reduce transmission. However, my point about sharing cars to and from work still stands, as people share cars if they are not on large incomes or if they live in rural areas such as mine. Also, at the start and end of shifts large numbers of workers are squashed into a small space to get in and out of the workplace, so there are lots of opportunities for workplace transmission.

The employer said to me, “Well, we have told people that if they don’t feel safe, they can go home, but we won’t pay them and we won’t furlough them.” That is not acceptable behaviour from an employer in 2021. It is simply unacceptable that they leave people feeling exposed and at risk but then say, “It’s up to them, but we won’t pay them. They can stay at home with no money.” I live in a fairly poor area, and that is not an acceptable prospect.

Here is what I hope might happen—that the Government and the public authorities accept that employers and employees have a duty and an obligation to try to eliminate covid at work and elsewhere. I do not think it is good enough simply to leave it to the employers. The public authorities need to intervene in hotspot areas and identify what is going wrong. Although the figures in my area are going down quite rapidly, as a multiple of the average, they are horrific, really. It is unacceptable that we are in this situation.

On Tuesday I spoke to Wakefield Council leader Denise Jeffery. I asked whether it was possible for her public health people to identify hotspots of transmission and move in—almost like a hit squad—to test and trace, and perhaps also accelerate the vaccination programme, although that might undermine the Government’s age-related vaccination priorities.

Will the Minister reflect on the points that I have raised and could we have a further exchange, to see what can be done to tackle this chronic problem? I thank the House for listening so courteously.

[Mr Philip Hollobone (in the Chair)]

The debate can last until 11.30 am.

11:20

[The Parliamentary Under-Secretary of State for Health and Social Care (Jo Churchill)]

It is a pleasure to serve under you, Mr Hollobone. I congratulate the hon. Member for Hemsworth (Jon Trickett) on securing time for this important debate and showing that one reason why Westminster Hall is important is that it enables us to discuss the local as well as the national.

I very much associate myself with the hon. Gentleman’s thanks to those who have worked so hard to keep us safe through an unprecedented time for our country. I agree that we come from different communities, but the underlying issue is that none of us is safe until everyone is safe; I keep that in mind as I respond to his points.

In case we run out of time, I should say that I will of course meet the hon. Gentleman again because some of his points relate to key things that we want to work on. I know that directors of public health and his local authority have been doubling down on this issue because it is very important that we suppress. Although we are on a downward trajectory, we are all going to have to learn to live in a covid-tinged world, so we need to be aware of the things that he has highlighted.

Covid-19 has highlighted health inequalities across the country. As the hon. Gentleman said, his constituency was a mining community and some disease types are particularly prevalent among men there. We often see higher rates of smoking in areas such as the one that he represents. All have been a keen focus for me during the past 18 months or two years, and also for the Office for Health Promotion going forward, because all these things need to be looked at in the round.

I emphasise that as we rebuild from the pandemic, we are committed to tackling the long-term problems and levelling up. People should have the right to good healthcare, a good life and good life expectancy, wherever in the country they live. The NHS has committed to inclusive recovery from the pandemic and has set out eight actions to reduce inequality in the restoration of services. I do not cover hospital services, on which the hon. Gentleman spoke at some length, but he is free to write to the Minister for Health, my hon. Friend the Member for Charnwood (Edward Argar), who looks after those. Reporting on providing services to the poorest in our areas is one of the actions.

My focus has been, and remains, tackling inequalities through the health and social care system and promoting health among disproportionately disadvantaged groups, because targeting everybody often only enlarges the gap. The hon. Member for Hemsworth highlighted several issues, and targeting and focused approaches work better.

The best way to improve life expectancy and reduce health inequalities is to prevent health problems from starting in the first place. Prevention is one of the top five areas for the health service and it is my focus, going forward. In March, we announced that the Office for Health Promotion would lead the national effort in improving and levelling up public health. That will enable a more joined-up, sustained approach and action between the NHS and national and local government. The hon. Member talked in the end about how we drive these interventions to address the wider determinants of health, ensuring that we have longer, better quality years and that we drive down health inequalities through the health and social care policy.

The West Yorkshire and Harrogate Health and Care Partnership supports some 2.7 million people and takes a place-based approach, which is totally right, to highlight the strengths, capacity and knowledge of those involved. Wakefield clinical commissioning group has developed a health inequalities prevention pathway and housing for health network—as we know, some of the determinants do not always sit within health; they sit in other areas, such as the quality of work that people have, and the homes in which they live—to support the reduction of barriers to services and deliver the recommendations from our ethnic minorities review.

That collaborative work has led to good practice being shared that saves lives and prevents illness. That includes the Healthy Hearts project, which the hon. Member for Hemsworth probably knows well. It originated in Bradford, but has been scaled up right across West Yorkshire and Harrogate, aiming to prevent 1,200 heart attacks and strokes over the next 10 years. The partnership also launched a new targeted prevention grant fund worth £100,000 to help reduce the gap in health inequalities across the area, supporting targeted, community-level preventive interventions that reduce harmful health behaviours, improve health outcomes and support those disproportionately affected by covid-19.

I wonder whether there is some targeting, because on some of the things that the hon. Member mentioned, such as people travelling in cars—I know exactly what he is alluding to, as my background is in construction—it is about ensuring that we all reinforce the messages: “If you are sharing a car, do not sit next to somebody; sit with a distance between you. Keep windows open and wear face masks.” All those things are important.

We will build on action that we have taken to limit the impact in West Yorkshire. The local teams, with national support, have managed outbreaks in many kinds of settings, and have done a brilliant job, including in care homes, meat factories, bed factories and general practice surgeries and within the professional football team. I know that covid-19 has affected some groups disproportionately. The Public Health England review last July identified age, occupation and ethnicity as particular risks. We therefore built up the community champions scheme, providing nearly £24 million to local authorities and the voluntary sector to improve communication for those most at risk.

The scheme is investing nearly £1.4 million to support ethnic minority groups across communities and faiths in Bradford, Kirklees, Leeds and Wakefield. We have mobilised 700 volunteers and are training 300 residents locally. In Wakefield, we have developed specific covid-19 and vaccine messages, working with English for speakers of other languages tutors, and community leaders such as mosque and black African church leaders. Community champions have contributed to the successful vaccination programme, as has the rolling out of information in different languages. That may also be something that we need to look at doing more effectively, but we have done a great deal of work on it. We can take that up at a further meeting.

The NHS has met the target for offering everyone in the cohorts their first vaccine by mid-April. More than a million people in West Yorkshire have received their first vaccination, in line with the national uptake rate. Vaccines were distributed fairly across the UK. It was a mammoth job. Somebody always has to be at the top and somebody not so near the top, but there is now much more balance. We have targeted the top nine groups. They are those at most risk from dying if they catch covid. That is the strategy that the Joint Committee on Vaccination and Immunisation, Jon Van-Tam and the Secretary of State have spoken about many times, explaining that we are protecting the most vulnerable.

I am aware of various barriers to vaccine uptake, but we have focused on that gap and driven it down, and it is now diminishing. We are working across Government to consider how we best support people and produce tailored outreach services, providing materials in a variety of languages and formats. We have also used outreach to approach targeted areas and communities.

There is a duty of care on workplaces to their employees to ensure that workplaces are covid-secure. It is only by us all working in lockstep that we can give everybody the same opportunity to have long, healthy lives wherever they live, wherever they work and whatever their background. Learning from the ways in which things have been done—the different deliveries—will help us going forward. I am happy to meet with the hon. Member, but the Department and I are determined to tackle both the long and short-term health inequalities that remain in Yorkshire, and to ensure that we help people.

Motion lapsed (Standing Order No. 10(6)).

11:25

Sitting suspended.