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Mr Kevan Jones (North Durham) (Lab)
I beg to move,
That this House has considered public health in County Durham.
It is a pleasure to serve under your chairmanship, Mr Owen. I am pleased to have secured this debate, but it is unfortunate that we have to have a debate on public health to highlight the effects that the Government’s cuts have on one of the poorest counties in our nation. I thank the men and women of the NHS, those who work in public health for the county council, and the voluntary and community sectors, which are part of the matrix of support for delivering in County Durham not only general healthcare, but, importantly public health.
In recent years, there has been debate about Government funding not just in health, but in local government and other areas. That debate starts from the premise that everywhere is the same, so a fair funding formula spreads the jam evenly around the country, but I am sorry—that is just not the case. Deprivation and need are factors that must be taken into consideration. In local government funding, fire service funding and police funding, need and poverty have been removed as determinants.
County Durham is a large rural county of 525,000 people. It faces some unique issues on health, partly because of the legacy of the county’s industrial past of coalmining and heavy industry, which means a high incidence of diseases associated with those industries, such as respiratory diseases, which put particular demands on the health service.
We also have a legacy of rapid deindustrialisation in the 1980s, when the hearts of many of the coalmining and steel communities across County Durham were ripped out by the policies of the Thatcher Government. That legacy remains in terms of hopelessness, drug and alcohol abuse, obesity and smoking, as well as the poverty that goes with all that. Previously, I have described County Durham as a rural county with urban problems, but those urban problems are sometimes ignored because of County Durham’s rurality.
We also have a growing elderly population. In the period to 2035, the number of people aged 65-plus will rise by 31%, and the number of people aged 85-plus will rise by 82%. That puts particular demand on the health service at all levels, in both the community and the acute sectors. Life expectancy in Durham is 78.3 years for men and 81.4 years for women. I will mention two other counties, and allude to the reasons for doing that later in my remarks: in Surrey, life expectancy is 81.5 years for men and 84.8 years for women, while in Hertfordshire, it is 81 years for men and 84.2 years for women.
The figures for healthy life expectancy, which indicates the age at which people develop serious health concerns, are even worse. In County Durham, they are 58.9 years for men and 58.7 years for women, whereas in Surrey, they are 68.3 years for men and 68.7 years for women, and in Hertfordshire, 64.9 years for men and 65.9 years for women. People in County Durham who get long-term health issues get them sooner than people in more affluent areas, which leads to demand on our health service. We are always told by the Government that we need to stop people using the health service to reduce the demand placed on it, but unless we tackle some of the underlying causes of the problem that pressure will continue.
Responsibility for public health funding was transferred from the Department of Health and Social Care to local government in 2013-14. I supported that move because public health is best delivered locally. The budget devolved to County Durham in 2013-14 was £40.5 million, based on the assessment of health needs by the primary care trust, which was abolished under the same legislation that introduced the transfer of responsibilities. To give credit to County Durham, it has used that money effectively, with services commissioned both directly by the county council and externally by private and third-sector organisations.
As with many things, however, devolution of responsibility for public health came with a sting in 2016, when the budget was reduced by 12.8%. That was part of George Osborne’s strategy, in a host of areas, to devolve money locally and tell the local authority to decide where the cuts would come. He could then stand back and say, “That decision has to be made locally.” But that misses the point. By sleight of hand, he sought to give the idea that somehow he had no responsibility for the cuts when he had top-sliced the budgets.
To be fair to County Durham, its public health priorities were the right ones to tackle. The funding was directed towards the control of tobacco and cessation of smoking, teenage pregnancies, obesity and weight reduction, mental health—an issue close to my heart—and improved dental services. I do not know whether the Minister is aware of this, but when I was first elected in 2001, certain areas of my constituency had no access to dental services at all. That has changed—not since 2010, I hasten to add, but certainly under the last Labour Government.
County Durham also targeted drug and alcohol addiction. I give it credit for the work that it has done on that. In the light of the recent confessions of the Conservative party leadership contenders, I think that they could take note of the available drug and alcohol services. However, unlike those middle-class people who have confessed to drug use, the young people we are talking about will not go on to glittering careers in the media or elsewhere. They will be pushed into a cycle of poverty and desperation at local level, and will add to our shared tax burden, because their demand on health, police and other services will increase. I always look at public health as an investment in our local communities to ensure not only that we have good public health outcomes, but that we reduce demand elsewhere in the system.
Helen Goodman (Bishop Auckland) (Lab)
Before my right hon. Friend moves on to the next section of his speech, I want to congratulate him on securing this important debate. What shocks me is the fact that in Woodhouse Close in my constituency, the healthy life expectancy is 10 years lower than that in Barnard Castle, yet those two places are only 10 miles apart. The notion of cutting public health funding seems grotesque.
Mr Jones
My hon. Friend is correct. She highlights that example in County Durham, but there are many more between the more affluent areas and the pockets of poverty. They have been there since the 1980s and they need to be addressed. I am passionate about this issue; the idea that where someone lives should determine how long they live, in a wealthy country such as ours, is wrong. We should be able to tackle that in this day and age.
The new funding formula, ironically called the fair funding formula—trades description comes to mind—is based on the premise, pushed mainly by a lot of Conservative Members, that somehow the needs of individuals in health and other areas are the same across the nation. That is just not the case. The methodology put forward by the Ministry of Housing, Communities and Local Government means that County Durham will lose 38% of its existing budget—that is £18 million a year. It is the worst loser in this process, because the dedicated, ring-fenced public health budget is being abolished. It is being pushed in terms of the business rate retention scheme, which concerns me because it means that there will be areas where councils—I will refer to two in a minute—that get a budget increase will have no duty at all to ring fence that money and put it into public health. That is a retrograde step.
County Durham has achieved a lot: smoking is 22% down and teenage pregnancy is down to a level that is no longer statistically different from national averages. That certainly was not the case when I was first elected in 2001. We have made great strides getting cardiac mortality down from 31 deaths per 100,000 in 2001 to 5.7 deaths per 100,000 by 2015. A lot of effort has gone into addressing suicide rates, particularly among men. That is a credit to multi-agency work, including the police, the voluntary community sector and others. We have a good-news story in the sense that we have a good partnership-working approach in County Durham, yet the Government want to take that budget away.
People ask, “Why can’t it be made up from elsewhere in the council budget?” This is a county council that has had its budget slashed by nearly £240 million since 2010. It is due to lose another chunk of funding under the so-called local government funding formula. The scandalous situation, and the reason I mentioned Surrey earlier, is that, while County Durham will have its budget cut by 38%, Surrey County Council’s budget will be increased by £14.4 million a year, and Hertfordshire’s by £12.6 million a year. It cannot be right—I will give some reasons in a minute—that money is being moved from deprived areas such as County Durham in the north-east to some of the most affluent areas in the United Kingdom. The life expectancy and other figures that I mentioned earlier are not comparable. That is not a fair way of distributing that money.
It is not just County Durham that is affected; the north-east loses some £40 million under the proposals, in some of the most deprived parts of this country. Gateshead, for example, loses 12.44% of its budget; Redcar and Cleveland loses more than 27%; South Tyneside, one of the most deprived parts of the region, loses 29%; and Sunderland loses 24%. That will not address health inequalities and stop people going into the health service; the cuts to the most deprived areas cannot be right.
There is a deliberate policy—not just here, but in other areas—of moving the central Government grants or funding formulas to benefit mainly Conservative-voting southern areas. That is the worst example of pork barrel politics. The Conservative party leadership contenders talk about one-nation conservatism. If this is one-nation conservatism, they can keep it. The cuts will have a direct effect on the ability of healthcare professionals to provide services. It is not acceptable to go backwards on smoking cessation and drug treatment.
What has been going on? The county council has lobbied; it has written to the Minister, met Public Health England and worked with other local authorities not just in the north-east but elsewhere, such as Blackpool Council, which is also affected. It has contributed to the fair funding review. It is not just politicians on the Labour county council; the health and wellbeing boards, the police and crime commissioner, and the local NHS trusts have all argued that this is not correct, because they see what is coming down the road. If these short-sighted cuts take place, the demand on local acute services will go up—exactly what the Government and NHS England want to avoid. That disjointed approach beggars belief.
What do we want in County Durham? We want and need a clear commitment to public health. That is referred to in the NHS forward plan, but with no funding commitment or power to ensure that local councils deliver good-quality public health. We need a form of funding that reflects need. We also need a clarification on timetable. I understand that a decision is being kicked right back to the spending review. When the spending review will take place, given the chaos in the Conservative party, I do not know.
There is real pressure on the county council and other bodies because they have to let contracts—the current contracts come to an end in March next year. If there is no clarification by the end of this year, that will not leave much time for those organisations not only to tender but to let those contracts. That will lead to a lot of organisations worrying about their future. A lot of public health is delivered by the local voluntary community sectors. They rely on that, and they do a fantastic job. We cannot have money deliberately moved to areas of prosperity. I challenge the Minister to conduct an impact assessment on the effects of the cuts, to highlight those effects.
It does not surprise me what the Government are doing because they have done it in every other area, particularly local government funding. I do not question the commitment of the Minister to good-quality public health, but there is a disconnect in relation to the funding formula and the Ministry of Housing, Communities and Local Government. On 7 January, I asked the Health Secretary directly about the issues concerning County Durham. He said:
“That is obviously not right. Indeed, there is a whole section of the plan on reducing health inequalities, which is extremely important.”—[Official Report, 7 January 2019; Vol. 652, c. 77.]
He might recognise the importance of public health, but MHCLG does not. That is not a very good example of joined-up government.
This is not charity; it is an investment, not just in the lives and wellbeing of individual constituents in County Durham but in the future of the country. Unless we tackle some of these health inequalities through good public health, our efforts to relieve the pressures on our health service will come to nothing. In a statement on exiting the EU, the Prime Minister, who will not be with us much longer as Prime Minister, said she wanted to work
“across all areas to make this a country that truly works for everyone, and a country where nowhere and nobody is left behind.”—[Official Report, 10 December 2018; Vol. 651, c. 25.]
If these cuts go through, those words will be pretty hollow, because County Durham will be left behind.
Phil Wilson (Sedgefield) (Lab)
It is a pleasure to serve under your chairmanship, Mr Owen. I congratulate my hon. Friend—
Phil Wilson
He is my right hon. Friend, as he reminds me. I congratulate my right hon. Friend the Member for North Durham (Mr Jones) on securing this timely debate. He has been a real campaigner on this issue in County Durham for many years, and I know he takes a real interest in the public health issues we face in Durham.
The backdrop to the debate is this: we face cuts to public health provision in the north-east of England, primarily in County Durham, at the same time as we see a parade of candidates to be leader of the Conservative party, virtually all of whom want to cut taxes by billions of pounds. I am beginning to wonder where exactly the money will come from for any kind of public sector provision. Those claims of future tax cuts will probably end up being unfunded after Brexit, considering that the pot of tax money for the public sector will be reduced anyway.
As my right hon. Friend said, we may face cuts to public health services of around £18 million in Durham. I reiterate what he said about Surrey and Hertfordshire: under the new formula, there will be a £14.4 million increase for Surrey and a £12.6 million increase for Hertfordshire. That cannot be right when we consider the problems we have with health and healthcare provision in Durham. Sedgefield grew up, as a community, on coal. The number of men who worked down the collieries and are still alive today but have ailments related to that industry, such as lung disease and arthritis, just goes to prove that there is a requirement not to cut funding but to increase it.
If we look at random at some areas of health, we see that the figures for Sedgefield are worse than the national average in all of them. It has higher than the national average cases of dementia, patients on antidepressant drugs, patients on painkillers, asthma sufferers, people with high blood pressure, people with depression—the list goes on and on. We are talking about a formula devised by algorithm rather than by listening to what healthcare professionals say the county needs. People in Durham can expect to live a decent life in good health for seven years less than people in Surrey and nine years less than people in Hertfordshire.
Great strides have been made over the years in the use of the public health grant in County Durham. For example, the smoking rate has reduced from 22% to 14%. However, smoking during pregnancy is still an issue and still above the national average. About 20% of the people who live in Durham—I think that is about 114,000 people—are under 19. They should all be due some kind of safeguarding provision. If the cuts go ahead, will we have the health visitors to provide that? The cuts will affect the safeguarding of young people. If drug and alcohol services are reduced, the police will have to deal with an even greater problem of rising crime.
The chief executive of the Tees, Esk and Wear Valleys NHS mental health trust came to see me about the cuts a couple of weeks ago. Because of cuts to public health, fewer and fewer health visitors and school nurses are going to schools and people’s homes. Because that provision is not there, the trust has to see people it would not otherwise have seen because they would have been seen at home or school. Its provision for people with mental health problems is being put under more and more stress. The cuts are impacting on services other than those provided through public health funding.
One thing for which public health services have mandatory responsibility is health visiting services for those under the age of five. The breastfeeding initiation rate in County Durham is 59%, compared with 74% in England as a whole. Health visitors play a pivotal role in helping and encouraging women to continue to breastfeed their babies until they are at least six months old. Public Health England guidance acknowledges:
“Mothers who are young, white, from routine and manual professionals and who left education early are least likely to breastfeed.”
Cutting the public health grant to an area in which many women fit that profile and which is already way behind on breastfeeding rates would once again penalise an area with real need.
Then we have obesity. In the fight to keep the population healthy and active, healthy weight is of core importance to the public health agenda. An estimated 14% of adults on GP registers across the Sedgefield constituency are obese, with the figure in some areas as high as 19%. Five of the 15 neighbourhoods with the highest rates of obesity are in County Durham. In the south-east, which may end up with increased public health provision, those rates are in single digits—around 8%, if not less. In Richmond Park, the figure is 3.6%.
The common theme in all this is that if we cut public health provision in our communities, other providers will be affected. Those providers, which otherwise would not have had to provide those services, will end up doing more and more. The mental health trust told me that case loads are skyrocketing for some of its workers. How, for example, will they be able to look after young people with mental health issues that are not picked up at school or in the home? Those young people will be passed along the road to mental health trusts, which will not be able to cope because they, too, face cuts. That needs to be addressed.
Mr Kevan Jones
Does my hon. Friend agree that, especially in mental health, the outcomes for an individual are better if we intervene early, at a young age, rather than leaving problems untreated for many years?
Phil Wilson
That is absolutely right, and that is an issue that the mental health trust raised. If those issues are picked up in the early years or when someone is still at school, they can be resolved. Leaving them just puts extra strain on the mental health trusts in the area.
I want to end on a positive note. I had some schoolchildren in Parliament yesterday from the primary schools in Ferryhill and Chilton. Cleves Cross Primary School in Ferryhill has a whole host of initiatives around mental health, eating properly and so on. Around the village, it is setting up edible walkways: instead of flower beds, it is planting vegetables, which people can pick when they mature. It is great that schools are coming up with those great initiatives, but if the same thing is to happen in schools across Country Durham, there needs to be central provision from public health services.
For wellbeing, there are initiatives to make sure that children have meals together with their families, and to ensure that if there are problems, other children and friends from school are invited along to share those meals. Such initiatives for those aged seven to 10 bode well for the future, and the public health service in Durham needs to look at them, but they must be funded.
We also need to think about how we develop best practice, so that we see such initiatives not just in Ferryhill and Chilton but in Consett, Barnard Castle, Durham city, Esh Winning and Easington—all over County Durham. There needs to be some strategy. As my right hon. Friend said, we need some kind of audit or impact assessment of what cuts to public health mean to areas like ours. What is the reasoning behind making cuts in Durham, where services are needed, and increasing funding in places such as Surrey and Hertfordshire, where they will not be?
Albert Owen (in the Chair)
Order. Before I call Dr Roberta Blackman-Woods, I remind Members that this an hour-long debate. I will call the Front-Bench speakers at 5.25 pm, with five minutes for the Opposition and 10 minutes for the Minister, allowing Mr Jones a couple of minutes to finish the debate.
Dr Roberta Blackman-Woods (City of Durham) (Lab)
May I say what a pleasure it is to serve under your chairmanship, Mr Owen? I thank my right hon. Friend the Member for North Durham (Mr Jones) for bringing forward this important debate. In 2013, there was a general welcome for the transfer of public health funding to local government, because it meant that public health and addressing public health issues could be integrated into the council’s service delivery objectives to better promote public health objectives.
On transfer, the grant to County Durham was £44.5 million, based on an assessment of health needs in the county by professionals—albeit one heavily influenced by the Government’s austerity programme. It is therefore extremely alarming that the Government now plan to move to determining the county’s grant level not on need but according to a new formula, under the huge misnomer of the “fair funding review”—it is anything but. The public health grant to County Durham will be reduced by a massive 38% while resources are transferred to more affluent areas of the country that have much better health outcomes. That is clearly madness and cannot be right.
The public health team in County Durham has done a good job, despite facing the hugely complex health issues discussed in some detail by my right hon. Friend. The county has an industrial past of heavy industry that has left a huge legacy of negative health impacts on the local community. Despite that, and through use of the public health grant, public health professionals, to whom we all pay tribute this afternoon, have done much. They have reduced smoking prevalence and teenage conceptions, and they also provide excellent support for vulnerable families on health and wellbeing issues, including access to mental health services. Those positive changes will be very much put at risk by the massive reduction in funding. In fact, given the severity of the problems Durham faces, it should be given more funding, not less.
Public health professionals in Durham have to address not just the problems of our industrial legacy but high current levels of poverty, because proper regeneration of the county has not taken place as yet. For example, just one food bank said that it gave out 20,000 emergency food bank parcels in Durham last year. We are talking about massive levels of poverty. Almost a third of children in County Durham are being brought up in households affected by poverty. Increasingly, such households are those with parents in work, sometimes having to do multiple jobs just to make ends meet.
Mr Kevan Jones
Under the last Labour Government, my hon. Friend, along with my hon. Friend the Member for Washington and Sunderland West (Mrs Hodgson), pioneered a free school meals initiative. Is she alarmed that, as I learned yesterday, the national school breakfast programme, which costs only £12 million nationally and affects quite a few schools—primary schools in particular—in her constituency, my constituency and other parts of County Durham, has still not had its funding guaranteed for next year?
Dr Blackman-Woods
My right hon. Friend makes an important point, which I am sure my hon. Friend the Member for Washington and Sunderland West (Mrs Hodgson) and I will take up in the coming weeks. That is an indication of how little the Government seem to be concerned about the children growing up in poor households.
Let us look at the Durham situation. The starkest indicator is the seven-year healthy life expectancy gap between females in Durham, currently at 59, and those in Hertfordshire, where it is 66, and Surrey, where it is 68. That gives rise to the question of why the Government are transferring resources from County Durham to Surrey and Hertfordshire. I know the Minister is new to her post, but it would be helpful to get an explanation of why the Government think that is a good idea, because we have not had one so far. The appalling health inequality is compounded by overall life expectancy figures, which for women are 81 in Durham compared with 84 for Hertfordshire and Surrey. There is a similar gap for men.
Let us look at other measures. Suicide rates in County Durham were above the national average, with 20.6 deaths per 100,000 of the population for males. On mental health, the rate of young people admitted to hospital because of self-harm is significantly above the national average. On alcohol, 33.8% of people in County Durham drink more than the low-risk guidelines recommended, and 290 people died due to alcohol-related problems last year. There were also 12,500 hospital admissions and 108 road traffic accidents. That suggests a significant problem that needs to be addressed.
Furthermore, the percentage of mothers smoking at the time of delivery is above regional and national averages. As my hon. Friend the Member for Sedgefield (Phil Wilson) made clear, breastfeeding rates are low, yet we know that it provides the best nutrition that babies and young children can get. Seven out of 10 adults in County Durham are overweight or obese, significantly more than the national average, and cardiovascular mortality rates are also higher than the national average.
I could go on with endless statistics, but we are making the point that County Durham is an area with high levels of disadvantage and poverty. It is below the national average on almost every public health indicator imaginable, yet what are the Government doing? They are not giving additional funds to address those problems and ensure that our services continue to improve; they are threatening to take money away.
The workforce would be significantly affected by this measure. There would be a significant reduction in the number of visits that health professionals could make and the universal work on emotional wellbeing would be removed. Instead, only higher level and more targeted work would take place, although we know that misses most of the families and individuals who would benefit from services. Other prevention priorities, including visits and programmes trying to address problems around smoking at the time of delivery, breastfeeding, unintentional injuries and obesity, would also be reduced. The service would have to focus on safeguarding, which would increase inequalities, and issues would be missed.
I could go on and on. We have already seen a massive reduction in services. For example, my constituency has no Sure Start centres operating, which means there is nothing in place to bring together services that could support very vulnerable families. Can the Minister look at that issue as well?
What do we want the Minister to do? The point was put forcefully by my right hon. Friend the Member for North Durham: we need a commitment from the Government to increasing public health funding in line with need; an extension to public health funding to be used in areas where the grant has been utilised effectively; and clarity on the timescale for decisions. We have already seen concern in County Durham about future funding, especially from the voluntary sector organisations that do much of the heavy lifting in terms of providing services to improve public health outcomes. The Government do not seem to be aware that funding for such organisations is often precarious and that they need some certainty from the Government to invest in staffing and services for the future.
The Government should certainly not be moving money from areas with the greatest health inequalities to those with the least health inequalities. They should be carrying out an impact assessment of any funding decision, so that we are really clear about what the impacts of that massive reduction of 38% in County Durham would lead to. As my right hon. and hon. Friends have said, this is an issue across north-east England. I look forward to hearing what the Minister will say to address this problem.
Mrs Sharon Hodgson (Washington and Sunderland West) (Lab)
It is a pleasure to serve under your chairmanship this afternoon, Mr Owen. I thank my right hon. Friend the Member for North Durham (Mr Jones) for securing this important debate and for his excellent speech. I also thank my hon. Friends the Members for Sedgefield (Phil Wilson) and for City of Durham (Dr Blackman-Woods) for their insightful and powerful contributions.
As I have said many times before, under the Tory-led coalition and the current Conservative Government, public health budgets have been cut by £700 million since 2013, with no financial settlement agreed so far post-2020. As we have heard, that means that vital public health services, such as those for smoking cessation, obesity, sexual health and many more, have been stripped back to the bare minimum. That has consequences: gonorrhoea is at its highest level in 40 years and syphilis at its highest level in 70 years; rates of smoking among pregnant women have risen for the first time on record; and Victorian diseases, such as scarlet fever, whooping cough, malnutrition and gout, have seen a 52% upturn since 2010, with an increase of over 3,000 hospital admissions per year.
Life expectancies are stalling and, in some places, declining, with the north-south divide as wide as ever in terms of health and productivity. For a number of us in this Chamber, it was the north-south divide that drove us into politics; to see it as wide as ever, and not closing, drives us to come to debates such as this one. This is a welcome opportunity to highlight and discuss public health in County Durham.
Overall, health and wellbeing have improved significantly in County Durham, but it still remains worse than the England average. Although it has improved in the north, the rest of the country has also improved, so the gap remains wide. In addition, large health inequalities still remain across County Durham, especially with regard to breastfeeding, babies born to mothers who smoke, childhood obesity and premature deaths. The impact becomes obvious when we look at life expectancy. As we have heard, a child born today in the most deprived areas of County Durham can expect to live between seven and eight years less than one born in the least deprived areas.
With that in mind, it is concerning and shocking that County Durham is the worst affected local authority in England when it comes to cuts to the public health grant. Current predictions suggest that Durham County Council will lose £18 million this year from its public health grants. To put that into perspective—I will repeat the figures we have already heard, because they are more shocking the more times you hear them—this means County Durham will be receiving an £18 million cut to public health budgets but Surrey County Council will receive £14.4 million extra and Hertfordshire County Council will receive a boost of £12.6 million.
What assessment has the Minister made of this funding disparity between councils in the north and south, and the impact that has on health outcomes? Does she agree with me that where there is need, funding should follow? How will the Minister support Durham County Council in delivering vital public health services to those who need them most?
The current grant for County Durham, with a population of 525,000, is £47.4 million, which equates to £90 per head. Does the Minister believe that this is a substantial amount of funding per person to tackle all the public health issues, as well as look at prevention for smoking, alcohol and drug misuse, obesity and weight management? Does she believe that £90 per head is enough to also fund early years services, nutrition and physical activity programmes and support mental health and wellbeing services?
As has already been mentioned, there is a life expectancy gap between the north and south of England: it is clear that money follows higher life expectancies, rather than the other way around—or, indeed, deprivation—as it used to. In County Durham, women have a healthy life expectancy of 59. That is compared with Hertfordshire, where women have a healthy life expectancy of 66, and Surrey, where it is 68.
Albert Owen (in the Chair)
To give time for the Minister, can the hon. Lady finish up, please?
Mrs Hodgson
Yes, I will. I ask the Minister: when will the Government agree a future funding settlement for public health? I am under the impression that this has been postponed now until after the leadership contest. Local authorities and public health services need to know where they stand. As my right hon. Friend the Member for North Durham said when he opened the debate, we cannot have County Durham or other local authorities being left behind any longer.
The Parliamentary Under-Secretary of State for Health and Social Care (Seema Kennedy)
It is a great pleasure to serve under your chairmanship, Mr Owen. I thank the right hon. Member for North Durham (Mr Jones) for raising this important issue, and the hon. Members for Sedgefield (Phil Wilson) and for City of Durham (Dr Blackman-Woods) for their contributions.
The Government fully appreciate the importance of protecting and improving the health of the population. We share hon. Members’ commitment to prevention and public health, which this debate has highlighted. The costs, both to individual lives and to the NHS, are simply too great to ignore.
The population in England is growing, ageing and diversifying rapidly. Some 40% of morbidity is preventable, and 60% of 60-year-olds have at least one long-term condition. Helping people to stay well, in work and in their own homes for longer is vital. As hon. Members have highlighted, the gap in healthy life expectancy between the most and least deprived areas of England is approximately 19 years for both sexes. As somebody who was born in Lancashire and represents a Lancashire seat, I see that disparity in my constituency. It is a great motivating factor for me in my role, as it was for my right hon. Friend the Prime Minister when she set her grand challenge of extending a person’s period of healthy, independent and active life by five years by 2035.
However, we will not achieve that by simply adding five extra years at the end of life; as with many things, the earlier we start, the more we stand to gain. Investment in early years and onwards is essential if we want positively to influence future lifestyle choices, prevent disabling conditions and enable people to contribute fully to society. We must continue to focus our efforts on areas such as digital technology and behavioural science so that we can show the public that the healthy choice is the easy choice.
We are doing work—on childhood obesity, smoking, air quality and more—that has the potential to make a real difference to people’s health and wellbeing. The amount of sugar in drinks has been reduced by 11% and average calories per portion have been cut by 6% in response to our soft drinks industry levy. By 2020, the NHS diabetes prevention programme will support 100,000 people at risk of diabetes each year across England. Last year’s ambitious prevention vision statement and the forthcoming prevention Green Paper will enable us to meet the ageing grand challenge and address health inequalities, supporting people to live longer, healthier lives.
We recognise that the funding position for local authorities is extremely challenging and understand the huge efforts that local government has made to focus on securing best value for every pound it spends. The 2015 spending review made available £16 billion of funding for local authorities in England over the five-year period. I remind the House that that is in addition to the money the NHS spends, which is part of the public health offer on prevention and includes our world-leading screening and immunisation programme and the world’s first national diabetes prevention programme.
Today’s debate has highlighted an important issue about the distribution of funding for local authority public health functions. Historically, funding for public health services in the NHS was left to local decision and was not necessarily based on need, which led to wide disparities in the amount of funding dedicated locally to public health services. Before these functions were transferred to local government, we asked the independent Advisory Committee on Resource Allocation to develop a needs-based formula for the distribution of the public health grant. The introduction of that formula meant that some local authorities received more than their target allocation under the ACRA formula and others received funding under target. In 2013-14 and 2014-15, when the overall grant was subject to growth, local authorities’ funding was iterated closer to their target through a mechanism called “pace of change”.
In 2015, ACRA was asked to update the formula to take account of the transfer of responsibility for commissioning health visiting services from NHS England to local authorities. We consulted on this formula and ACRA made recommendations to Government in 2016. I understand that the public health formula is more heavily weighted towards deprivation than either the adult social care formula or the clinical commissioning group formulation.
Seema Kennedy
Of course we want evidence. The shadow Minister says from a sedentary position that it is not working. We did an impact assessment in 2015-16 and we are reviewing all the evidence in preparation for the next spending review.
Phil Wilson
Just for clarification, did the Minister actually say that the formula is not working?
Seema Kennedy
No, I was repeating what the shadow Minister had said.
The recommended formula, which would create winners and losers in terms of overall levels of funding because of the disparity in historical spend compared with current need, has not been implemented because of the Government’s intention to extend the system of retained business rates. We continue to review the position, and future spending levels will be decided as part of the spending review, where we will review all available evidence.
I commend all local authorities on the efforts they are making to improve population health, as well as third-sector groups such as the children in Cleves Cross with their edible walkways. We continue to believe that local authorities are best placed to make decisions about the services that best meet the needs of their populations.
Dr Blackman-Woods
I am sure the Minister would accept that any formula that moves services from areas of relatively high need to areas of low need cannot be working properly. Does she also accept that it is simply not fair to push the onus to provide more services on to local authorities? As my right hon. Friend the Member for North Durham (Mr Jones) made clear, Durham County Council’s budget has been cut by 60% since 2010.
Seema Kennedy
I believe that local authorities and local communities are the right place for public health to be situated, because they best understand the needs of their communities.
Seema Kennedy
May I just finish addressing the point made by the hon. Member for City of Durham? I also want to ensure I give the right hon. Gentleman, who moved the motion, time to wind up the debate. We recognise that there has been pressure on local authorities and we commend them for the work they have done. As I have said, we continue to review the position, and future spending levels will be decided as part of the spending review.
Seema Kennedy
I think public health is ring-fenced, and local government does have to use the funding for that. We are reviewing the position, and we will look at all the evidence carefully in the upcoming spending review.
Across England, we are seeing examples of councils adopting new service models and commissioning more effectively and innovatively. Stakeholders often tell us, most recently through the review of commissioning sexual health and health visiting services, that councils are achieving better value for money while maintaining or improving outcomes in challenging financial circumstances.
However, we need to acknowledge that improving public health is about far more than the grant, and we know that spending more money does not necessarily improve outcomes. What we spend it on matters a lot. That covers all local government activity, including transport, planning, housing and the economy, all of which contribute to population health and wellbeing. The work that local government does on the ground through place-based approaches makes joining up those different factors easier, and the NHS long-term plan has a significant focus on prevention and reducing health inequalities.
We do not know what the outcome of the spending review will be, but I am committed to working closely with local government and other partners to build on the achievements of the past six years. We need to take action on a local, national and global level to meet the public health needs of the present and rise to the public health challenges of the future.
Mr Kevan Jones
I thank the Minister for that. She is a new Minister, so I will give her a word of advice: do not come to a debate and just read out a civil servant’s speech, as she did today. It is all right her saying that she recognises the importance of public health, but in her position she needs to be a champion for public health. If that means giving the Ministry of Housing, Communities and Local Government a kicking, she needs to do it. Without that, demand will increase on her Department of Health and Social Care and its budget.
I am sorry, but I just do not accept what the Minister says about efficiencies. No organisation can have 38% taken out of its budget through efficiencies while delivering the same thing. Morally, this policy, which is like Robin Hood in reverse—taking from the poor and giving to the rich—is just not acceptable. I expect her to be a champion for public health, because all the evidence from this country and internationally—not from politicians for party political points—is that early and proper direction of public health funding not only reduces demand on the health service but improves people’s lives.
It cannot be right that one of the most deprived parts of the UK—the north-east of England, and County Durham in particular—has its budgets and its council’s ability to provide public health services to its population reduced because of a funding formula put in place by this Government. Other areas, which I and my hon. Friends the Members for Sedgefield (Phil Wilson), for City of Durham (Dr Blackman-Woods) and for Washington and Sunderland West (Mrs Hodgson) highlighted, have far fewer health needs.
We cannot take need out of the funding formula and hide behind the NHS long-term plan. The plan has all good intentions in trying to address health inequalities, but that will not be done without proper investment. Since 2013, Durham County Council has proven—in very straitened circumstances, and not just in this area but in how it has administered its budgets—that it has been able to get efficiencies. However, there is a limit to that, and taking 38% out will not work. This is simply not fair, Minister. As someone who represents a northern constituency, she should recognise that.
On whether we will see any change from the new leadership of the Tory party, if the front-runner gets it I very much doubt that. My hon. Friend the Member for Sedgefield is correct: directing money to tax cuts for the wealthy will not mean a growth in public services. Public health is not a luxury; it is a vital part of a strategy not only to tackle inequality, but to tackle unfairness and to make people’s lives better.
I went into politics to make people’s lives better, as I am sure the Minister did. Her Government—I accept that it is not her Department, but the local government Department—are making people’s life chances worse. That cannot be right.
Question put and agreed to.
Resolved,
That this House has considered public health in County Durham.