Health and Social Care Bill

Debate between Baroness Greengross and Baroness Murphy

Monday 7th November 2011 Lords Chamber

[Baroness Greengross]

My Lords, I will speak to Amendment 33 in my name. I am pleased to follow the noble Baroness, Lady Williams, and the noble Lord, Lord Turnberg, because a lot of my work is concerned with the sort of inequalities they have spoken about. The noble Lord, Lord Turnberg, mentioned Professor Sir Michael Marmot. I have been privileged to chair the advisory group for the longitudinal study on ageing that he established. I have done that since it started. It demonstrates so clearly the terrible, almost life-or-death sentences that health inequalities impose on different groups in terms of their life expectancy. This is really something that is quite impossible for us to continue.

My other role as the lead commissioner on age at the Equality and Human Rights Commission means that I hope very much that we can, if we amend this Bill, achieve more positive healthcare outcomes. The Bill, in order to achieve that, must be explicit that improvements have to be achieved across the whole population, not just some parts of it. We know that one group whose needs are currently very often underprioritised and underrecognised is older people, particularly within the NHS. Sadly, ageism persists in clinical practice—very often older people lag behind other groups in terms of better healthcare outcomes. I am very concerned that unless a clear obligation to demonstrate that improvement is being achieved across the whole population, the specific needs of older people will continue to lag behind those of other groups or sometimes to be ignored and similar existing health inequalities may even be maintained and strengthened.

My amendment would define the Secretary of State’s duties to reduce health inequalities against three different criteria: the definitions of equality contained in the Equality Act 2010; different parts of England; and different socio-economic strata. In any subsequent reporting of progress towards reducing health inequalities, the Secretary of State would have to demonstrate consistency in the progress made against the three criteria.

My amendment would clarify the Secretary of State’s duties in relation to reducing health inequalities. I am afraid that without this in the Bill health service improvement may not reach everyone. There may be a failure to improve services for specific groups such as those mentioned within the list of protected characteristics. Clause 3 currently requires the Secretary of State to have regard to the need to reduce inequalities between the people of England with,

“respect to the benefits that they can obtain from the health service”.

The amendment to this clause would ensure that access to health services and improving health outcomes were an intrinsic part of the Secretary of State’s duties. Without guaranteeing improvement in access to services, there is a risk that there could be high levels of variation in the kinds of services the NHS provides across the country.

I have listed the equality characteristics detailed in the Equality Act 2010 which is not necessarily Members of your Lordships’ House. Too often it has been the case that health inequalities exist in part because people belong to one of the groups listed here and there is actual discrimination against a patient. In relation to specific treatments, patients are treated differently not purely on the basis of clinical decisions but on the basis of one of the protected characteristics, particularly age. For example, despite improvements in cancer outcomes, a 2007 study of breast cancer patients in Manchester found that older women are less likely than younger women to receive “standard” management for breast cancer and less likely even after accounting for differences in general health and co-morbidity to have surgery for operable breast cancer.

My amendment will ensure that the Secretary of State’s duties are clear and specific and that people across England can be sure their access to healthcare and the quality of the healthcare they need will be assured regardless of who is providing the service. The areas where the Secretary of State can demonstrate improvement in reducing inequalities should be balanced and fair in their focus. The risk otherwise is that commissioners will be incentivised to invest their efforts in improving health outcomes for those groups where they believe they can make the easiest and quickest gains and some groups, including older people, risk being shunted to the sidelines. This must not happen.

[Baroness Murphy]

My Lords, I have a great deal of sympathy with those who want to beef up this duty on the Secretary of State. I want to ask the Minister to explain why the public health function was left out—it is very specific about NHS responsibilities. I suspect the answer is that public health is in relation to other departments of state. He is shaking his head so perhaps that is not the answer. Working in the NHS one cannot but be aware of these profound inequalities. Within the first week of going as chairman to the east London health authority, three facts hit me in the face. First, in Hackney, people had only a 25 per cent chance of referral for a hip replacement as per the norm for England. Secondly, in Newham, mortality rates for bowel cancer after treatment were 30 per cent worse than elsewhere. It clearly emerged that there was a failure of referral to access, for, particularly, certain of the ethnic communities. Thirdly, on a visit to the community podiatry service, every patient was white in an area where the population was 25 per cent black and minority ethnic. Simply, no one had ever asked them the relevant question. Addressing inequality seems to be profoundly difficult on the ground: you must have the information and the wit to discover whether there is a problem of access, referral or discrimination and treatment, or whether there are underlying features of the illness that make inequalities difficult to address.

Pensions Bill [HL]

Debate between Baroness Greengross and Baroness Murphy

Wednesday 30th March 2011 Lords Chamber

[Baroness Murphy]

My Lords, I am sure that the noble Baroness, Lady Greengross, will be here to speak to her amendment in due course, so I am speaking on her behalf. This is not a filibuster despite the comment I have just overheard. In Committee I spoke to the suggestion that we should have a halfway house and that there should be an amelioration of the difficulties that some people will face. I have today supported the Government in the main thrust of their policy but I think that a modest change to help the few who need it would be very helpful indeed. I am now assured that the noble Baroness is in her place, and no doubt she will outline her amendment in more detail. I beg to move.

[Baroness Greengross]

My Lords, I start by thanking the noble Baroness, Lady Murphy. I am sorry; I did not realise that people had come back into the Chamber. I hope that my amendments will be seen as both positive and fair. They represent a compromise and would ensure that, if the Bill becomes law, no women born between 6 October 1953 and 5 April 1955 will have to work for more than one extra year before they receive their state pension. This is a particularly vulnerable group which was eloquently described by the noble Lord, Lord German, in his remarks on the previous amendment.

We know that life expectancy is rising much faster than many of us had realised, and during the Second Reading debate on this Bill I accepted the argument that rises in the state pension age must take place. However, I also said that while I understand completely that deficit reduction is a priority for the Government, this legislation could have a hugely negative impact on certain women. It will have a negative impact on many women, but some groups will be particularly affected. The 33,000 who are the worst affected will face a two-year hike in their state pension age. They will not have any possible opportunity—because they will not have had notice—that will enable them, even if they could, to plan financially for this delay in getting their state pension.

This group of women will be particularly and disproportionately hit by the Government’s proposals. It will also be the second time that these women have had their state pension age changed. Many will also be totally unaware of the changes and they will not be in any way prepared for them. Many of these women, as the noble Baroness, Lady Hollis, illustrated graphically, will be single women and women on lower incomes, who face, as we know, lower life expectancy on average. Many of them have not had a chance to accumulate any form of private pension. They will be reliant solely on the state pension. Many of these women care for older parents or younger grandchildren, and sometimes both at the same time.

Furthermore, the timetable proposed in the Bill is faster than that laid out in the coalition agreement, which promised that the state pension age would not start to rise to 66 until 2020 at the earliest. I do not think I am alone in having received many letters illustrating this point from people who are going to be caught out by this change, which would in any case not offer any immediate help in cutting the deficit, because, as we have heard, there will not be any savings until 2016, by which time the Government plan to have eliminated the current deficit.

The figures in the table I have produced have been verified by some key experts in the pension field as dealing with a particularly difficult problem. Many people I know feel very strongly about this matter and by accepting these amendments the Government could—and I hope will—demonstrate that they want to help the people most affected and worst affected by this necessary reform of the state pension age. I very much hope that the Minister will support my amendments.