Tackling Obesity

David Evennett Excerpts

Tuesday 27th February 2024 Westminster Hall

[Sir David Evennett (Bexleyheath and Crayford) (Con)]

I beg to move,

That this House has considered the matter of tackling obesity.

It is a pleasure to serve under your chairmanship this afternoon, Mr Dowd. I am incredibly grateful to be able to raise the important subject of tackling obesity, which I believe is vital to our country’s future. I am grateful to see colleagues here from both sides of the House, as tackling obesity requires a cross-party approach. I particularly welcome my right hon. Friend the Minister, who is also a personal friend. I have worked closely with her in the past, and I know how interested in and concerned about this issue she is.

Obesity is a major public health problem and a global concern. According to the World Health Organisation, worldwide obesity has nearly tripled since 1975. Most of the world’s population live in countries where issues associated with being overweight or obese kill more people than issues associated with being underweight, and 39 million children under the age of five were overweight or obese in 2020. These are quite shocking statistics. However, the problem is of particular concern in the United Kingdom, where we have the third highest obesity rates in Europe, behind only Malta and Turkey, and where we have the third highest in the G7, behind only Canada and the US. Almost one in three adults here is now classified as obese, a dramatic increase from the one in 10 adults in 1970. The increase in this country has been much greater than in other western European countries, such as France, Germany and Italy.

The health survey for England monitors trends in our national health and care. It found that a higher proportion of men than women were either overweight or obese—69%, compared with 59%. The highest rates of obesity were found among the lowest socioeconomic groups. Almost 70% of people in the most deprived quintile of English localities are classed as living with obesity or being overweight, compared with 59% of those in the richest.

[Jim Shannon (Strangford) (DUP)]

I commend the right hon. Gentleman on securing this debate and apologise to him in advance: but for an AGM that I am attending at five o’clock, I would have participated in the whole debate.

According to the Department of Health back home, 65% of adults in Northern Ireland are obese, which is quite a shocking figure. There are now plans for a consultation, which highlights the need to make healthier food more affordable. Does the right hon. Gentleman agree that this must be a priority for every region of this great United Kingdom of Great Britain and Northern Ireland, and that that must be done in partnership with our own agrifood sector? It has a role to play—maybe a financial role, as much as a role in guidance. When it comes to the Minister’s reply, does the right hon. Gentleman agree that partnership with the Department for Environment Food and Rural Affairs might be advantageous?

--- Later in debate ---

[Sir David Evennett]

I am grateful to the hon. Gentleman for giving us that information from Northern Ireland. Of course, this is something that we need to work on across all four of our countries that make up the United Kingdom. I am sure that co-operation is the best way forward.

Behind these statistics are real people—our people, not just statistics: parents, grandparents, children, friends and neighbours. Overweight people are more likely to experience other health issues as a result of excess weight. There are real consequences, too, for the quality of life of our people. People who are obese are seven times more likely to develop type 2 diabetes. Some 11% of obese adults reported in the health survey for England that they had a diagnosis of diabetes from a doctor. The figure was less than half that among overweight adults, at 5%, and it was just 3% among those who were neither overweight nor obese.

People with obesity are two to three times more likely to have high blood pressure and other consequential health issues. Obesity is a risk factor for depression and is associated with social isolation and less physical activity, contributing to an increased risk of dementia. Obesity between the ages of 35 and 65 can actually increase dementia risk in later life by some 30%. Of course, excess weight puts strain on joints, increasing the risk of musculoskeletal conditions. Other health problems from excess weight include cardiovascular disease, liver disease and many common cancers. Obesity is actually the second biggest preventable cause of cancer.

As well as the costs to individuals’ health and wellbeing, there is the real cost to the economy, businesses, jobs and communities. The Times reported yesterday that 60 senior health experts—including the heads of the Royal College of Physicians, the Royal College of Anaesthetists, the Royal College of Midwives and the Royal Society for Public Health, and dozens of health charities—have written to my right hon. Friend the Chancellor of the Exchequer, urging him to put tackling obesity and other public health issues at the heart of his Budget next month, for the sake of the economy. The plea is not just about healthcare, but about the economic vitality and future of our country. That coalition of doctors, scientists, charity bosses and food campaigners say that

“poor health is one of the greatest…threats”

facing Britain today and warn that it is damaging the economy in ways ranging from

“the size and strength of our labour market; to productivity; to growth and GDP.”

They also say that

“the vast majority of health conditions contributing to…economic problems are driven by poor diets, alcohol and tobacco.”

They cite the work of the independent Times Health Commission, a year-long inquiry that called for stronger Government intervention to tackle the growing obesity crisis and that recommended a number of interventions to combat obesity, including expansion of the sugar tax, curbs on cartoons on packaging and a pre-watershed ban on junk food advertising on television. The experts urge the Chancellor to issue a formal call for evidence on

“financial and non-financial health policy options that…make it easier for everyone to lead healthy lives—by shaping the environments they grow, learn, work and play in.”

They conclude by advising:

“The public overwhelmingly believe the government should have a stronger role in acting to create healthy lives and to take pressure off the NHS.”

The Times editorial of yesterday, under the heading “Body Politic”, gives a convincing account of the issues and the need for action. It also notes that merely increasing taxes on already hard-pressed consumers is not the way forward; we should be encouraging the switch to healthier products. I agree with that assessment and find it increasingly worrying that Frontier Economics estimates that in 2023 the total economic impact of obesity was £98 billion, accounting for the costs to the NHS and social care, lost productivity, work inactivity and welfare payments.

Obesity-related ill health does reduce workforce productivity. People living with obesity are estimated to have four extra sick days a year. That is approximately equivalent to an extra 37 million sick days across the UK working population. Estimates put the annual cost of obesity at 1% to 2% of GDP. With obesity rates continuing to soar, that is only likely to increase. Obesity places a heavy burden on the NHS. It contributes to high workloads in GP surgeries, hospitals and social care, adding to the pressures that we are already experiencing.

Tackling obesity has actually been on the political agenda for many years. In 1991, the then Conservative Government recognised that obesity was a sufficient threat to the health of the nation to warrant specific action. The first target for reducing obesity rates in England was set and was to achieve a return by 2005 to the 1980 level of 7%. Sadly, that target was missed. Over the last three decades, there have been various strategies, countless policies and many reforms, with key agencies and teams created and abolished. Despite that, and as highlighted in the statistics that I have mentioned, the issue is still very prevalent.

In my own borough of Bexley, the issue of obesity is one where, statistically, we are performing relatively badly—unlike in other areas, where Bexley performs extremely well. Last month, Bexley was dubbed the fattest borough in south-east London, after the Office for Health Improvement and Disparities published information on the percentage of adults over 18 who are classified as obese. According to the report, Bexley has the worst obesity rate in south-east London at 28% of the population, yet in recent years we have been successful in my area on health issues. The stop smoking campaign was a great success, and I was privileged to be involved in it. The number of smokers in our borough has considerably reduced because of campaigns by the NHS and the council, as well as people like me adding to those campaigns.

We have real issues with childhood obesity, and Bexley council has endeavoured to be proactive in improving the health of people across the borough, as well as implementing an obesity strategy in 2020. Despite that, childhood obesity rates in Bexley have worsened following the coronavirus pandemic. Figures by NHS Digital show that 745 of 3,095 year 6 pupils measured in Bexley were classed as obese or severely obese in 2022-23. Across England, 13.9% of year 6 pupils were overweight and a staggering 22.7% were obese or severely obese. That was slightly down on the previous year, but still higher than pre-pandemic figures.

That is extremely worrying, and childhood obesity is a major public health concern in its own right. Children who are obese are five times more likely to become obese as adults, and that puts them at higher risk of the conditions previously highlighted, as well as shortening their life expectancy. As the majority of obese children will remain obese as adults, early intervention is essential. We have to act early in their lives before they suffer complications later on due to something that was avoidable.

The Government have taken some action on childhood obesity. In 2018, they set a target of halving childhood obesity in England by 2030 and reducing the gap in obesity between children from the most and least deprived areas. While it is necessary, meeting that target unfortunately does not seem possible at this time. Despite all the health problems, the impact on lives and the cost to the economy, we must remember that obesity is preventable in many cases. Action is required by individuals, parents, schools, the Government, media and the food and drink manufacturers.

What can and should be done? Basically, as a nation, we are simply consuming too many calories each day. According to Public Health England, many adults consume an extra 200 to 300 calories a day over what they need, while children who are overweight or obese often consume an additional 500 calories a day. The NHS needs to do more, as public health improvement will ease the pressures on GPs and hospitals.

Of course, there needs to be an emphasis on the individual in tackling obesity. At an individual level, people can limit their energy intake from fats and sugars, increase their consumption of healthy food, particularly fruit and vegetables, and engage in regular physical activity. People who are overweight or obese may also benefit from joining a local weight loss group, or even from receiving support and counselling from trained healthcare professionals to help them to better their relationship with food and develop different eating habits. More publicity, promotion and education on food, nutrition and the consequences of a bad diet are absolutely essential.

Although that is important, tackling obesity is not just about individual effort; we need to see cultural and environmental changes too, while ensuring that everybody is given the necessary information to make healthy choices. Because of our fast-paced lives, our eating habits have changed in recent decades. There is a huge increase in people eating fast food, and more people are eating out, eating higher-calorie foods and buying hot food from takeaways that is high in fat, salt and often sugar. While it is good to see businesses thriving, it is incredibly worrying that some are exacerbating the problem and increasing the sugar and calorie intake of our nation. Treats are fine, and we should not be Job’s comforter on these sorts of things, but they should be for special occasions, rather than the mainstay of an individual’s diet.

Our food environment affects our behaviour and has a significant part to play in reducing obesity. Parents are crucial in this as the primary educators, and education is vital. It can be difficult to make healthy choices if someone is blissfully unaware of the content of the food they are eating. I know from personal experience that, when we do the weekly shop, identifying the healthiest products is not always easy. That is why we have to ensure the labelling of products in shops, cafés, restaurants, coffee shops, fast-food outlets and the rest, so that individuals can make an informed choice. Essentially, the healthy option should also be the easier option on the menus for everyone. Research shows that when Governments act on this issue, they have a positive effect. Our own Government have done excellent work in this area. The voluntary traffic-light scheme, which was introduced jointly by the UK Government and devolved Administrations in 2013, has been incredibly successful. Restrictions on the placement of unhealthy foods in supermarkets and shops have been hugely popular, and they stop shops using children and pester power to hassle adults into buying those items. The soft drinks industry levy has had an impact by encouraging reformulation and decreasing the volume of sugar in soft drinks.

However, more needs to be done, and advertising on television is still a real concern. Restrictions before 9 o’clock are due to come into effect in October 2025, having been originally planned for 1 January 2023. That delay is disappointing but understandable. These actions need to be taken, and I know that my right hon. Friend the Minister will take them on board in the dynamic way that she does in her role.

In conclusion, serious action is needed, and tackling the obesity epidemic is a responsibility for all of us—the Government, schools, families, industry, and politicians—whether local, regional, national or whatever. Everyone has a part to play. It is also something that I think we can unite on across this House, because it is an issue that affects everyone’s constituents and every person in the country. I know that the Opposition and Government would want to work together with the Scottish nationalists, and others in the Chamber, to ensure that we do this. If we do not, it will cost our NHS billions of pounds a year and have a huge detrimental economic impact. Most importantly of all, it affects our constituents, and particularly our children.

With strategic policy interventions, we have an opportunity to turn the tide against obesity, improve our nations’ health, enhance people’s quality of life, prevent needless early deaths and secure the economic future of our nation. I hope that my right hon. Friend the Minister will carefully consider what I have said, and that colleagues on both sides of the House will endorse the fact that action is required.

--- Later in debate ---

[Sir David Evennett]

I thank everyone who has participated today in a very constructive way. That is the way we should all be addressing such an important issue. I particularly thank the Minister for her excellent response. We have had some really good issues raised by colleagues on all sides, and by the Minister.

I look forward to us all doing something to make sure that the crisis of obesity is overcome. It is so important, particularly for our children, but also for adults, and for quality of life. I am grateful for Members’ participation and for the ideas that have come forward, which we will look at and consider. I know the Minister will take them away, and I particularly thank her.

Question put and agreed to.

Resolved,

That this House has considered tackling obesity.

Oral Answers to Questions

David Evennett Excerpts

Tuesday 23rd January 2024 Commons Chamber

[Helen Whately]

We have a plan for the social care workforce, and it is working. The social care workforce increased by over 20,000 last year, and it is still going up. But I will take no lectures from the hon. Member. In fact, his hon. Friend the Member for Bristol South (Karin Smyth), early this morning on television, made it clear that Labour does not have a plan for social care—or if it does, it is clear that it will cost a lot of money and is yet another unfunded Labour plan.

[Sir David Evennett (Bexleyheath and Crayford) (Con)]

9. What steps she is taking to help improve men’s health.

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

I assure my right hon. Friend that this Government are committed to improving men’s health. That is why, in November, we announced a suite of measures, including a £16 million fund for a new prostate cancer screening trial, and the recruitment of a men’s health ambassador. We have also launched our men’s health taskforce to tackle the biggest health issues facing men.

[Sir David Evennett]

I thank the Minister for that answer, and I would urge her to continue to make men’s health a top priority. In particular, can she look at how we can detect prostate cancer better and sooner? It is the most common cause of male cancer in the United Kingdom, and anything that can be done to reduce that number will be most welcome.

[Maria Caulfield]

I thank my right hon. Friend and male colleagues on the Government Benches, including my hon. Friend the Member for Don Valley (Nick Fletcher), who are fighting so hard to improve men’s health. He is absolutely right: 12,000 men a year die from prostate cancer. That is why we are investing in the £16 million prostate cancer trial called Transform, using methods such as MRI to detect prostate cancer rather than PSA, which can be inaccurate. Thousands of men will be recruited. We are hoping that the trial will start in the spring, with recruitment in the autumn, including the recruitment of black men, who are disproportionately affected by prostate cancer.

NHS Winter Update

David Evennett Excerpts

Monday 8th January 2024 Commons Chamber

[Mr Deputy Speaker]

I am sure that we all wish to welcome Sir David Evennett back to the House in rude health.

[Sir David Evennett (Bexleyheath and Crayford) (Con)]

Thank you, Mr Deputy Speaker. I welcome my right hon. Friend’s factual statement on the state of the NHS in her winter update. Will she confirm that she would return to the negotiating table immediately were the BMA to call off these very damaging strikes?

[Victoria Atkins]

I welcome my right hon. Friend back. I have said throughout this that I was extremely disappointed that the committee chose to walk away from discussions. I also think that there is a lot more to discuss apart from pay—I have made it clear that I would like to look at other aspects of their working conditions—but, unfortunately, the junior doctors committee walked out. The strike action has had a real-terms impact on patients. We need to find a fair and reasonable solution, but I will not do that while the junior doctors committee maintains strikes. It will have to come to the table with reasonable expectations and change their minds on the validity of strike action.

Oral Answers

David Evennett Excerpts

Tuesday 25th April 2023 Commons Chamber

[Steve Barclay]

The whole House will send their best wishes to the hon. Lady’s constituent. She raises an important point about genomics, which is why we have invested in Genomics England and 100,000 babies are being screened—that is a key programme of work. The Minister for Health and Secondary Care, my hon. Friend the Member for Colchester (Will Quince) recently hosted a roundtable with key stakeholders on that, but I am happy to write to her with more detail, because the prevention and capability that is offered through screening is a great way of getting early treatment to people.

[Sir David Evennett (Bexleyheath and Crayford) (Con)]

13. What progress his Department has made on increasing the number of GP appointments.

[The Secretary of State for Health and Social Care (Steve Barclay)]

I think the question is about GPs and workforce capability, and that is why we are investing in more doctors. We have recruited over 5,000 more doctors, including an additional 2,000 doctors in primary care.

[Sir David Evennett]

An increasing number of my constituents are having difficulties obtaining appointments in GP surgeries. However, I was pleased to learn that the GP workforce in my constituency of Bexleyheath and Crayford has increased by an estimated 75% since September 2019. Will my right hon. Friend confirm what further steps he is taking to continue growing the workforce in general practice, which is so crucial to increasing the number of appointments available?

[Steve Barclay]

Now that I have found the right page in my notes I can be precise in telling my right hon. Friend that it is a 75.7% increase in his constituency, so he is absolutely right about that. Nationally, we have recruited an additional 25,262 full-time equivalent primary care professionals, so that is expanding the workforce capability in primary care. As my hon. Friend the Minister for Health and Secondary Care said a moment ago, it is part of our £1.5 billion investment in the workforce in primary care.

Urgent and Emergency Care Recovery Plan

David Evennett Excerpts

Monday 30th January 2023 Commons Chamber

[Steve Barclay]

One area of the right hon. Gentleman’s question where I do agree with him is the importance of local authorities. One reason I am keen to see more clarity on data and transparency is that there can sometimes be a tendency for the local authorities to be blamed for discharge, when often it is factors within the NHS that contribute to some of those who are fit to leave hospital not doing so. On the money allocation, the £2.8 billion is targeted to local authorities—funding set out by the Chancellor—with £4.7 billion the following year. We are increasing the money for local authorities, but alongside that we are working with them to improve the data so that we can see where there are blockages due to local authorities. For example—Mr Speaker will be familiar with this—Blackpool often has visitors from out of the area, so the NHS there deals with a number of local authorities, not simply the nearest one. We are working intently on how we support local authorities as part of the wider discharge package.

[Sir David Evennett (Bexleyheath and Crayford) (Con)]

I welcome my right hon. Friend’s statement and commend his approach to this difficult problem that he faces and we as a nation face. Does he agree that while speeding up discharge from hospital and freeing up beds for patients needing urgent and emergency care is absolutely necessary, there is a real need for the expansion of new services in the community, which must be a top priority? In my area, one of the biggest reasons for bed blocking in hospitals is that there is no community service to pick up when people go home.

[Steve Barclay]

My right hon. Friend hits the nail on the head. He is right: it is about how we better manage demand in the community before people get to the emergency department. That is where, for example, action targeted at the frail elderly is so important. It is also about how we enable people to discharge sooner, where they are fit to do so, so that they can recover, whether in a community setting or, ideally, at home, with the right wraparound support.

Health and Social Care Leadership Review

David Evennett Excerpts

Wednesday 8th June 2022 Commons Chamber

[Sajid Javid]

This is none of the things the hon. Gentleman claims.

[Sir David Evennett (Bexleyheath and Crayford) (Con)]

I warmly welcome my right hon. Friend’s statement on the review and his strong support for inspirational leadership, which is key for our NHS. Does he agree that relevant training and career development are vital for all staff working in the NHS, to allow them to gain career advancement?

[Sajid Javid]

Yes, I absolutely agree.

Oral Answers to Questions

David Evennett Excerpts

Tuesday 19th April 2022 Commons Chamber

[Maria Caulfield]

I can let the hon. Lady know that interviews have taken place for a women’s health ambassador. We are expecting an announcement on the appointment any day now. We will be publishing the women’s health strategy in the coming weeks.

[Sir David Evennett (Bexleyheath and Crayford) (Con)]

I welcome all that my right hon. Friend is doing to address health inequalities. However, could I ask him to look carefully at public health funding for my borough of Bexley, as we are seriously underfunded compared with similar boroughs in London?

[Sajid Javid]

I would be very pleased to meet my right hon. Friend to discuss that further. I am sure he will welcome the publication of the upcoming health disparities White Paper.

Oral Answers to Questions

David Evennett Excerpts

Tuesday 1st March 2022 Commons Chamber

[Sajid Javid]

I think we all agree, across the House, about the importance of mental health services, especially for younger people. As for what the Government are doing, before the pandemic there was already a commitment to increase funding for mental health services in the NHS’s long-term plan by an additional £2.3 billion a year. On top of that, there has been the response during the pandemic, with the mental health recovery action plan and the additional £500 million that I referred to a moment ago. When it comes to children’s mental health services, there is £79 million included, which will pay for an extra 22,500 referrals.

[Sir David Evennett (Bexleyheath and Crayford) (Con)]

2. What steps his Department is taking to increase NHS capacity.

[The Secretary of State for Health and Social Care (Sajid Javid)]

We have worked with the NHS to expand virtual wards and establish a new national discharge taskforce to safely maximise patient discharge and free up beds. We have also announced a delivery plan for tackling the covid-19 backlog of elective care, which sets out our clear vision for how an additional £8 billion will be spent over the next three years to help the NHS to recover and expand elective services.

[Sir David Evennett]

I thank my right hon. Friend for that information. As we look beyond the pandemic, our priority must be tackling the NHS waiting list. Does my right hon. Friend agree that the record number of doctors and nurses working in our NHS shows that the Government are putting the NHS on the best possible footing to meet the challenges ahead?

Public Health Funding: Bexley

David Evennett Excerpts

Tuesday 26th October 2021 Westminster Hall

[Sir David Evennett (Bexleyheath and Crayford) (Con)]

I beg to move,

That this House has considered public health funding in Bexley.

It is a pleasure to serve under your chairmanship, Sir Edward—I have a long-standing friend in the Chair, which is always good news. I am grateful of the opportunity to raise public health issues, which are of great concern and importance to my constituents in Bexleyheath and Crayford, as well as to the residents of Bexley borough in general. I am delighted to see my neighbour and friend the hon. Member for Erith and Thamesmead (Abena Oppong-Asare) in her place today.

In my opinion, Bexley is by far the best place in London to live, work or visit. We have great local amenities, considerable green open spaces, over 100 parks, and a variety of places to visit: Danson Park, Hall Place and Gardens, and the Red House, to name just a few. It is a well-run, Conservative-led borough, and I am pleased to live in Barnehurst myself, in the constituency.

Today I want to focus on the public health situation in Bexley and highlight a number of concerns about funding. This is a matter that I have raised before and held meetings with Ministers about, but regrettably it has not yet been satisfactorily addressed. There are areas of public health in which Bexley does better than elsewhere in England, but also a number in which we are lagging behind.

I commend the work done locally, particularly by Bexley Council and Bexley clinical commissioning group, which have done some fantastic work over the years on so many issues, particularly against smoking. The Bexley stop smoking services help thousands of people to stop smoking, which is saving lives and improving our community’s overall quality of life. The service has won a number of awards and was recognised by Public Health England for reducing smoking rates and introducing highly effective tobacco control initiatives. During the covid-19 pandemic, the team continued to provide specialist weekly support on the phone, and over the last year they have helped some 534 people to quit smoking.

That is a real achievement, yet in other areas we are not so fortunate. In Bexley we have problems such as obesity. Action is needed to improve the situation. For Bexley residents, obesity poses a significant challenge, as we have among the highest rates of obesity anywhere in London, with 23.4% of children classed as overweight or obese when they start primary school. This is a really concerning figure, which continues to rise as they get older, with 36.6% of children aged 10 to 11 leaving primary school with excess weight.

It is widely recognised by experts that once weight is gained, it is difficult to lose. The Government have called childhood obesity one of the top public health challenges for this generation. This is most certainly the case for the residents of Bexley. Children who are obese are five times more likely to be obese as adults. This can put them at increased risk of long-term health conditions, including type 2 diabetes, cardiovascular diseases such as heart disease, stroke, cancer and musculoskeletal conditions, and can negatively impact on mental health, which is a real problem. In Bexley, 64.6% of adults aged 18 or over have excess weight, which is higher than in the rest of England and London in particular.

The Government are well aware of the problems associated with obesity nationally and are being proactive to address the concerns. Some of the welcome measures include the soft drinks industry levy, support for the Healthy Start voucher scheme to enable low-income families to buy fruit and vegetables, and action to increase physical activity in schools, but we also need a localised approach. It is in all our interests to live in a healthier borough, and in Bexley the local authority is always looking at innovative ways to help us live better and longer.

The Bexley obesity strategy does just that. Between 2020 and 2025, the strategy aims to reduce the rate of excess weight in children and adults by a minimum of 2%, with a stretch target of 5%, and to create healthy environments at school, in workplaces and throughout the borough. Just a few of the plans to achieve that include increasing the number of food businesses achieving the healthier catering commitment accreditation, developing a sustainable model for community cooking classes, reviewing compliance with school food standards across the borough, and installing public water fountains in town centres. While that will require hard work and dedication, it will also, as the Minister will be aware, require additional funding.

Aside from the work on stopping smoking and action to reduce childhood and adult obesity, Bexley of course has many other clear public health priorities, including diabetes, dementia, addiction and substance misuse, including alcohol. Mental health and children and young people’s emotional wellbeing are key public health challenges, on top of the additional challenges that the covid-19 pandemic continues to pose. However, good health also underpins a healthy economy. Bexley Council has a significant role to play in helping all Bexley residents to start well, live well and age well. That is why Bexley so desperately needs the unfairness in the public health funding formula to be looked at and addressed.

[Abena Oppong-Asare (Erith and Thamesmead) (Lab)]

I thank the right hon. Member for bringing forward the debate, which is very much needed in Bexley. As he has highlighted, Bexley’s public health grant is considerably lower per head than that of other London boroughs. My constituency includes part of Greenwich and Bexley. Does he agree that the Government should ensure that the public health allocation formula is updated, to guarantee that all his and my constituents have access to the high-quality public health services that they need?

[Sir David Evennett]

I am very grateful to the hon. Lady, my constituency neighbour, for raising that point. I totally agree, which is why we have the debate today. I am pleased she is here to reinforce the point for Bexley, and I am sure the Minister will be listening.

I have been provided with figures by Bexley Council to highlight inequalities in the public health grant received. The public health grant allocation for Bexley in 2021-22 is just under £10 million. That equates to a per head allocation of £39.84, giving Bexley the lowest funding across London. The average funding per head in London is £74.87. Therefore, Bexley’s mere £39.84 is just 53.2% of the London average, and a staggering £35 less per head.

To put that in perspective, if Bexley were to receive the same allocation as the London average, it would mean an additional £8.8 million for Bexley. That situation cannot be fair and puts our area at a significant disadvantage. Even if Bexley were funded at the same level as the second lowest London borough—Havering, across the Thames, and a very similar borough—an extra £750,000 would be added to Bexley’s allocation.

If we compare Bexley with other south-east London boroughs, the situation does not look good. If Bexley were funded at the average of all six south-east London boroughs—Bexley, Bromley, Greenwich, Lewisham, Southwark and Lambeth—it would result in an extra £8.25 million for Bexley. If Bexley were not included in the south-east London average and funded at that rate, it would mean an extra £9.9 million for our borough. If Bexley were funded in line with our neighbouring borough of Bromley, which receives £45.13 per head, it would see an additional £1.3 million for Bexley’s total allocation.

As we heard from the hon. Member for Erith and Thamesmead, our other neighbouring borough, Greenwich, has a grant allocation of £81.14 per head, which is more than double Bexley’s allocation. If Bexley were funded at Greenwich’s level, it would mean an additional £10.3 million for Bexley. I would point out, as the hon. Lady said, that Bexley and Greenwich share the town of Thamesmead, an area I represented in Parliament up until 1997. That is a community with some of our most complex and entrenched inequalities. Extra funding for Bexley would help to deal with those on the Bexley side of the Thamesmead divide.

Of the 151 local authorities in England, there are only 20 other local authorities with a lower per head grant allocation than Bexley. The main hindrance to Bexley is that the allocations granted remain largely dependent on historical patterns of spend before local authorities took over responsibility for public health. Although there have been years when the grant has increased, for which we are grateful, and other years when the grant has not increased or has been reduced, which we are not so happy with, no progress has been made towards tackling the issue of a fair and rational allocation for Bexley.

The result is that Bexley’s public health funding does not reflect its current population, public health needs or its ambitions to reduce health inequality. That has to be addressed by the Government. The covid-19 pandemic has worsened our position and exacerbated the conditions of poor health in Bexley, especially in the north of our borough, where there are the greatest levels of pre-existing, underlying health inequalities. Covid-19 has also disproportionately impacted and exacerbated the health inequalities of our growing black, Asian and minority ethnic population, and our over-75 population, which is higher than the London average.

Bexley has also seen some of the highest covid-19 case rates in London, which reflects the underlying issues caused by the lower public health grant and therefore lower investment in public health measures to counteract the effects of disproportionality and inequality. Even the pandemic response in Bexley, which covers outbreak management, surveillance, monitoring, communications and engagement, community testing and contact tracing, would not have been possible without the additional grants made available by the Department of Health and Social Care, and the Ministry of Housing, Communities and Local Government. Other local authorities have more in-built capacity and workforce resilience, which allows them to divert resources to address a future health protection challenge, such as a major epidemic, or the pandemic that we are currently experiencing. Bexley does not have the flexibility in the core public health capacity.

We are also currently seeing the development of the NHS South East London integrated care system. The ICS has set out its key priorities to be tackling health inequalities, prevention, and improving the health and wellbeing of residents. Each place-based system will play a significant role in delivering those priorities. With Bexley having such a low base for the public health grant, it will be extremely difficult to achieve parity with what the other south-east London boroughs can offer their residents due to significantly higher budgets. That alone will create further inequalities and highlights the importance of levelling-up grant allocation.

Bexley experiences the same public health challenges as other London boroughs and has an ambitious prevention strategy. Bexley’s prevention strategy is a whole-system, five-year plan to prevent illness and poor health and social care outcomes, as well as to actively promote a positive state of health and wellbeing for our residents. However, its funding allocation does not allow us the same opportunities to make positive changes to residents’ lives.

Bexley is a diverse, quickly changing and growing borough. It is a collection of communities working together and it is a great place. We anticipate a 7.6% population increase by 2030 and a 7.2% increase in the number of children living in Bexley. Some 30% of Bexley’s residents are young people under the age of 25, and Bexley has the fourth highest rate of people aged 65 and over in London, at 16.5%. That will increase to 21.8% by 2050. Our infant mortality rate is also 3.7 per 1,000 population and our neonatal maternity rate is 2.75 per 100,000, both of which are higher than the London average.

Hospital admissions for young people due to substance misuse are higher than the London average and our vaccination rates for childhood illnesses and for adult vaccinations, such as flu, are nationally lower. We have done a great job during the covid situation and our health service, our council and the doctors and pharmacists have done a fantastic job on vaccinations.

[Abena Oppong-Asare]

Will the right hon. Member take this opportunity to encourage constituents in Bexley to take up the covid booster jab and the vaccine when they are called to do so?

[Sir David Evennett]

Indeed I will. I had my booster two weeks ago. I think it is very, very important that people should get the vaccine, whether it is the first or second jab or the booster. That is the only way we are going to defeat this terrible disease and pandemic, and I totally endorse what the hon. Lady said.

Bexley is very fortunate to have excellent leadership on Bexley Council, both from officials and the political leadership under Councillor Teresa O’Neill OBE. I have worked with Councillor O’Neill over many years on many different campaigns, including to highlight public health issues and quality of life. We have met Ministers and been involved in debates here before, but this time we really need some action. Teresa and I are working very hard to persuade the Government that they need to look at the formula for public health funding for outer London boroughs such as Bexley.

Bexley desperately needs our grant to be urgently reviewed and redressed to reflect our needs and to support our constituents. I know that Bexley Council is appreciative of the national real-terms increase in public health grant allocations for 2020 to 2022. However, this historic funding issue needs to be addressed so that we can be a lead on the challenges we have today, and those we face ahead. Bexley Council is innovative, takes the initiative and leads in many fields. We want to do it here too, but without additional funding we cannot. I urge my hon. Friend the Minister to take these representations on board and to take action to ensure that my borough of Bexley gets a fair deal in public health funding for the future.

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

It is a pleasure to serve under your chairmanship, Sir Edward. I thank my right hon. Friend the Member for Bexleyheath and Crayford (Sir David Evennett) for raising the important issue of public health. I was delighted to hear of the many measures his local council is already taking on this issue.

This debate has provided an opportunity to clarify an often misunderstood position about how funding for public health is distributed. The Government fully appreciate and share the commitment to prevention and improving the health of the population highlighted today. Improvements in life expectancy appear to have stalled and, on average, 20% of our lives are spent in poor health, with people in the most deprived communities at far higher risk of poor health. The gap in healthy life expectancy between the most and least deprived areas of England is around 19 years for both sexes. Helping people to stay well, in work and in their own homes for longer is vital.

Ill health is not randomly distributed, nor is it inevitable. Our ability to avoid, manage and survive disease is influenced by the choices we make, the job we do, the air we breathe and the neighbourhood in which we live. Service funding is only one of the levers available to us to support better health. For example, our obesity strategy works alongside local public health efforts in reducing childhood obesity. Our overarching goal is to create a healthier environment, helping to improve people’s diets and to make the healthier choice the easier choice. The actions that the Government have taken on this can be seen in people’s daily lives.

For example, since the soft drinks industry levy came into effect, the average sugar content of drinks has decreased by 43.7%. We have also legislated to introduce out-of-home calorie labelling in April 2022, to help people be more informed about the food that they are eating. Moreover, we have put in place regulations to restrict the promotion by volume and location of products high in fat, salt and sugar in supermarkets, which will come into force in October 2022. In June 2021, we confirmed that at the end of 2022 we will introduce both a 9 pm watershed for television advertisements of HFSS products and a restriction of paid-for advertising of HFSS products online. All of these national measures will have a local impact and will undoubtedly help those living in Bexley.

We recognise that the funding position for local authorities is challenging and we understand the huge efforts that local government has made to focus on securing the best value for every pound it spends. Today’s debate has highlighted an important issue about the distribution of funding for local authority public health functions. Prior to 2013, funding for individual local health services, including public health, was determined by NHS primary care trusts. As for all local authorities, Bexley London Borough Council’s allocation is heavily based on historical NHS spend prior to 2013.

However, the introduction of the public health grant to local authorities in 2013 has meant that spending on this set of services is now much more transparent. Before these functions were transferred to local government, we asked the independent Advisory Committee on Resource Allocation to develop a needs-based formula for distribution of the public health grant. The introduction of this formula meant that some local authorities received more than their target allocation, and others received funding under target. In 2013-14 and 2014-15, when the overall grant was subject growth, local authorities’ funding was iterated closer to their target through a mechanism called “pace of change”. Bexley Council benefited from this policy and received the maximum amount of funding growth, which I am sure my right hon. Friend appreciated.

The Government decided in 2015 that the fairest way to make subsequent changes to public health grant allocations was via flat percentage adjustments. Since 2019-20, adjustments have been made to the grant to take account of additional cost pressures such as the 2018 NHS “Agenda for Change” pay deal and the launch of routine pre-exposure prophylaxis—PrEP—commissioning, with all local authorities receiving a cash increase last year and this year to the public health grant, so that they can continue to invest in prevention and essential health services. For this financial year, Bexley Council received more than £9 million for the grant. We also allocated additional funding of £358,000 to Bexley this year to tackle obesity and drug addiction.

Nationally, the Government have made more than £12 billion available to local councils since the start of the pandemic to address the costs and impacts of covid-19, with £6 billion non-ringfenced in recognition of local authorities being best placed to decide how to manage the major covid-19 pressures in their local areas. I thank the hon. Member for Erith and Thamesmead (Abena Oppong-Asare) for mentioning the covid booster vaccine and my right hon. Friend the Member for Bexleyheath and Crayford for having it, which is probably the most important thing that people can do to continue to build our wall of defence, protect lives and reduce hospitalisations from the pandemic. While Bexley’s per capita funding is different from other London boroughs, a per capita basis is not a meaningful way to compare or determine allocations, as it takes no account of different levels of need. We will consider the allocation of public health grant funding for future years following the outcome of the spending review; we do not have long to wait.

I commend all local authorities on their efforts to improve population health. Local authorities are ideally placed to make decisions about the services that best meet the needs of their populations. Across England, local authorities are commissioning more effectively and innovatively and delivering improved value, but we need to acknowledge that improving public health is about far more than only the grant. We know that spending more money does not necessarily improve outcomes. However, what we spend it on really matters. The whole range of local government activity, including transport, planning and housing, all contribute to population health and wellbeing. The place-based work led by local authorities makes joining up these different factors much easier, and the new Office for Health Improvement and Disparities supports all areas of the country to drive improvements in health.

[Sir David Evennett]

We are listening with great interest and are very grateful for what my hon. Friend has said. However, I urge her to look seriously at the funding for boroughs that have a change in demography, because Bexley is a different place from what it was in 2013. We are well led and innovative, so value for money is a top priority for the council.

[Maggie Throup]

My right hon. Friend makes an important point. Obviously, nothing is ever static. We can look forward to having those discussions after the spending review.

The Office for Health Improvement and Disparities has a particular focus on those places and communities where ill health is most prevalent. I thank everybody in Bexley for their dedication to improving the health of people in their area. I am committed to working closely with colleagues in national Government and local government and with partners to ensure that the public health needs of the present and future are met. This has been an extremely important debate. I am delighted that Bexley Council is taking forward so many measures to improve the health of its population.

Question put and agreed to.

Covid-19 Update

David Evennett Excerpts

Monday 28th June 2021 Commons Chamber

[Sajid Javid]

This is another very important issue. My hon. Friend is right to highlight the impact of the isolation that is demanded of children—understandably so, but it is having an impact on their education, their mental health and in so many other detrimental ways. That is exactly why I have asked for fresh advice on this. I want to see if there is anything more that we can do—any more flexibilities. I am aware that there is a pilot programme in place at the moment that certain local authorities are using whereby tests can be used in lieu of isolation, but I want to see if we can go further, and I will be happy to discuss that further with my hon. Friend.

[Sir David Evennett (Bexleyheath and Crayford) (Con) [V]]

I congratulate my right hon. Friend on his appointment as Secretary of State and wish him well.

In Bexley borough we have some of the highest-performing vaccination teams in the country, and we are all grateful to those involved for their tremendous work. However, will my right hon. Friend confirm that the vaccine roll-out remains his top priority, so that my constituents can be confident that we will defeat this pandemic, ease restrictions and see life return to normality after 19 July?

[Sajid Javid]

I can certainly confirm that to my right hon. Friend. As he suggests, the vaccine is the best way out of this pandemic. Let me share with him that four fifths of adults have had their first jab and three fifths have had both jabs—that is almost 77 million jabs across the country, with millions more to come. This is going to be our way out of this crisis, I am grateful for the huge amount of work that NHS staff and volunteers are doing in his constituency and throughout the country to achieve that and to get more and more people vaccinated.