Health Inequalities: Office for Health Improvement and Disparities

Debate between Andrew Gwynne and Derek Twigg

Wednesday 26th January 2022 Westminster Hall

[Andrew Gwynne (Denton and Reddish) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Twigg. I add my congratulations to my hon. Friend the Member for Bootle (Peter Dowd) on securing this debate and on the passionate way that he opened it.

Health inequalities are one of the defining issues of our time and are innately linked not only to how long we live, but to how well we live. Every person across this great country deserves to thrive and live a long, fulfilling and healthy life. That principle informed the creation of our national health service and it continues to drive the work that Opposition Members do.

As colleagues have done, I reinforce to the Minister the perilous position that we find ourselves in with regard to health inequalities. The pandemic has exacerbated the health inequalities that were already widening prior to the first lockdown. Indeed, in February 2020 the King’s Fund reported:

“Males living in the least deprived areas can, at birth, expect to live 9.4 years longer than males in the most deprived areas.”

For females, as we have heard, this gap is 7.4 years. That is not good enough.

Worse, the gap is increasing. Life expectancy has had a steady ascent for 100 years. That ascent began to plateau in 2011. Can the Minister advise what she thinks happened in 2010 that led to that abrupt stalling of life expectancy? It is very real. [Interruption.]

[Derek Twigg (in the Chair)]

Order. The sitting is suspended for 25 minutes for Divisions in the House.

--- Later in debate ---

[Andrew Gwynne]

Before I was interrupted by the Division bell, I was about to say that I have seen at first hand the injustice of health inequality. Denton, the main town in my constituency, where I grew up and have lived, is not a very large town. It has a population of 38,000 people spread over three council wards, and its area is 2.5 miles by 1.5 miles. I grew up in Denton West, which is one of the more prosperous wards in my constituency and in the borough of Tameside.

My best friend at secondary school lived in Denton South, which, conversely, is one of the poorest. We both went to the same school. We were two kids growing up in the same community, at the same school, doing the same things, hanging around together. Yet according to the average life expectancies, he will live 10 years less than I will. That cannot be acceptable, it is not acceptable, and it is one of the reasons I joined the Labour party and became politically active. Tackling those inequalities, not just in a small community such as Denton but across the country, is absolutely what we should be about, in order to improve outcomes for all.

The last decade has been a disaster in terms of inequality, and I say to the Minister that that is the direct consequence of political choices that her party has made. It is a consequence of a decline in real-terms local authority spending, a consequence of a reduction in per-person education spending—a consequence of 12 years of Conservative government. The fact is that it is impossible to corral health inequality into one box. As we have heard in this debate, it is closely tied to social determinants: where people grow up, their environment, their education and their disposable income all contribute to health inequalities. If we are to tackle the crisis, the Government must recognise that they cannot make policy decisions in a vacuum.

That leads me to the issue of the Office for Health Improvement and Disparities. I note that one of OHID’s key priorities is to

“develop strong partnerships across government, communities, industry and employers, to act on the wider factors that contribute to people’s health, such as work, housing and education”.

That is music to my ears. It is clearly a positive and welcome aspiration, but three months on from OHID’s launch, we have yet to see any clear indication that cross-Department work has actually been prioritised by the Government. This point has been made by the Inequalities in Health Alliance, an organisation with more than 200 members, including the Royal College of Physicians. The IHA has asked the Government to underpin and strengthen OHID’s work with an explicit cross-Government strategy to reduce health inequalities, involving all Departments, and led by and accountable to the Prime Minister. So far, the Government have been resistant to committing to that.

I would be grateful if the Minister, in her response, could advise us what assessment she has made of the request from the IHA and whether her Department will commit to developing a specific cross-Government strategy. In addition, can she set out how OHID will assess its own effectiveness, and what influence it will have on other Departments? Will she also outline what engagement OHID has had with other Departments since it was established back in October? We need to know that OHID is not just more warm words with very little in the way of positive action. The Government cannot point to OHID with one hand and then, with the other, undermine the work that it purports to do.

For example, last October, the very month in which OHID was formed, the Chancellor of the Exchequer ended the £20-a-week uplift to universal credit. That plunged 300,000 children into poverty pretty much overnight. That political decision obviously has a negative public health impact for people across the country, yet apparently that was not something the Chancellor either considered or seemed particularly concerned about at the time. Can the Minister advise us how OHID will prevent further such disastrous policies from being implemented? If she cannot, I simply do not see how it will solve the crisis of health inequality in this country. I would be grateful, too, if she could outline what role OHID will play with regard to the new integrated care systems. Some clarity on that would be very much appreciated, particularly in advance of the Health and Care Bill’s anticipated return to the Commons in the next few weeks.

Finally, I want to touch on the subject of levelling up and its relationship to health inequalities. It has become somewhat of a go-to phrase for the Government. It should perhaps be a cause of concern to the Minister that, more than two years into this Administration, the levelling-up White Paper still has not been published. On that note, I want to press her on what exactly the Government’s priorities are.

In 2020, Professor Sir Michael Marmot published “Build Back Fairer” in Greater Manchester, which called for several policy interventions from the Government. Professor Marmot proposed investment in jobs, housing, education and services, and made particular reference to tackling the social conditions that cause inequalities at local and community level. We saw local authority public health funding cut by 24% per capita in real terms between 2015-16 and 2020-21. That is the equivalent of a reduction of £1 billion, which cannot be right. We need to restore public health funding to local authorities, so that local teams are able to provide vital services that communities need to stay healthy.

In conclusion, we went into the pandemic with health inequalities already growing, which left Britain’s poorest areas, as well as those in black, Asian and minority ethnic communities, acutely vulnerable to covid-19. That is totally unacceptable. We are now in 2022; we should not be living in a society with such extreme levels of health inequality. It is not right, and it needs fixing. The Government must do more and can do more, and they must do better.

[Derek Twigg (in the Chair)]

The debate will finish no later than 4.25 pm. I know that the Minister is aware of the need to allow two or three minutes at the end for the hon. Member for Bootle (Peter Dowd) to wind up.

Harvey’s Law

Debate between Andrew Gwynne and Derek Twigg

Monday 2nd March 2015 Westminster Hall

[Derek Twigg]

The hon. Lady makes a powerful point, and I think everybody would agree with it.

Let me return to Harvey’s case. By chance, an employee of the contractor used by the Highways Agency saw one of the fliers that had been distributed about Harvey. She contacted the owners via a message on Facebook and said that she had collected Harvey’s body on the M62. It was only by chance that the owners were given that information.

In 2010, the Highways Agency took the decision to withdraw the routine scanning of domestic pets from highways so that their owner could be identified and notified. Area management memo 67/05, which is being phased out—this is what we have been talking about—states that highways contractors are supposed to scan a domestic pet for a chip, check for other details and contact the owner if possible. They should complete a log with all the details and notify the relevant authorities. The animal should also be kept in cold storage for a period of seven days or until the freezer is emptied, whichever comes first.

There is an odd situation, therefore, in that the Highways Agency is changing that practice, whereas the Government—rightly so—are implementing a policy of compulsory microchipping for dogs from April 2016. One Department is rightly ensuring that there is a legal requirement to have a dog microchipped, whereas the Department for Transport is taking a different view that does not really sit with that policy. It is quite bizarre.

As we have heard in various interventions and seen in the information that we have all received, the death of a pet is traumatic and deeply upsetting for an owner in any case, but when an owner does not know its fate—when the pet has gone missing—the situation is made much worse by not knowing whether their pet is alive or dead. They spend time looking, which, as we have heard from case studies today, can turn out to be wasted. That is obviously very costly, and it also makes the situation all the more unbearable for the families and owners concerned.

Hundreds of pets—probably thousands—are killed on our roads each year. Apparently, the figure is more than 300 for Highways Agency-managed roads, although I think that is an underestimate. As a result of my discussion with Pauline Krause, I wrote to the Minister to raise concerns about the Highways Agency’s stance on notifying owners about the change in policy. The Minister wrote back, saying:

“The Agency is currently phasing out contracts which include the Area Management Memo 67/05 to which your constituent Ms Krause refers. More recent contracts no longer mandate Agency contractors to scan or record pet identification details, or to contact the owners and the pet identification organisations. I know this current position will be hugely disappointing for all those involved with Harvey’s Law e-petition.

Increased investment in the Strategic Road Network brings the opportunity to focus more on the service we deliver for our customers. This could include a review of our current policy around this issue so potentially there may be an opportunity to change contractual arrangements in the future.”

I will come back to this point, but I hope that the Minister will change those arrangements now. When he talks about “delivering for our customers”, I think pet owners can be put in that category.

[Andrew Gwynne (Denton and Reddish) (Lab)]

My hon. Friend is making a very powerful case. Does he not agree that it seems contradictory for the Government to be mandating that pets should be microchipped—something that I very much support—but also instructing the Highways Agency that it is no longer a requirement for its contractors to notify the responsible authorities? If the Highways Agency does not have the scanners needed, it is easy to contact the local authority’s local dog warden service, which almost certainly will.

[Derek Twigg]

Again, I cannot disagree, but as I will come on to point out, the Highways Agency does actually have a lot of equipment. However, my hon. Friend makes a very good point, and I know that he takes a particular interest in this issue.

Managing Risk in the NHS

Debate between Andrew Gwynne and Derek Twigg

Wednesday 17th July 2013 Commons Chamber

[Derek Twigg]

My right hon. Friend makes an important point. That is one of the things that we explored during the Committee stage of the Health and Social Care Bill and of course we got no answers. The then Minister, now Minister of State, Department for Transport, the right hon. Member for Chelmsford (Mr Burns), said that as time goes on the NHS will be more open to the competition laws of both the EU and the UK. That is the real story here, and we will not have that transparency. That is a major part of the problem we are having to deal with.

No matter what statistics we are talking about, losing a friend or loved one is a massive human tragedy that affects everybody. We want to do all we can to reduce the number of early and preventable deaths—that is absolutely right—and put patients’ interests and those of families first. Given what we have heard in the last day or so, one would think that we somehow left an NHS in crisis—an NHS that was not delivering—yet when we left office it had the highest satisfaction rate in history. We had the lowest waiting lists in history and massive reductions in early deaths from cancer, coronary problems and so on. We also saw massive increases in doctors and nurses. We hear this Government talking about increasing the number of doctors, but when did those doctors start their training? They started under Labour.

To give an example, so that we can be a bit fairer about the situation, the Commonwealth Fund produced an international health policy survey in 2010 that looked at 11 countries—and guess what? The UK health service came out best. Just as an example, when those on above average incomes and those on below average incomes were asked whether they were confident that they would receive the most effective treatment if sick, the best results—95% and 92%—were in the UK. That was an international survey. Another question was whether people were confident that they would receive the most effective treatment if sick—and guess what again? The UK came out on top, at 92%. That is the real picture of the NHS that we left behind in 2010—although it was not without its problems and challenges, because pressures were always building up.

I also noticed that pages 4 to 5 of the Keogh report say—this is an important comment that has not been looked at much in the press—the following:

“Between 2000 and 2008, the NHS was rightly focused on rebuilding capacity and improving access after decades of neglect. The key issue was not whether people were dying in our hospitals avoidably, but that they were dying whilst waiting for treatment.”

That is where Labour made one of the biggest differences. I remember regularly having people write to me back in the late 1990s and the early 2000s about having to wait over two years for an operation. People were literally dying because of that. Addressing that was one of the biggest gains that Labour made.

The Secretary of State has now left the Chamber, but earlier I raised with him the issue of mortality. He refused to correct the record. He said that there had been a “slight” improvement by 2010, yet Professor Keogh talks about a 30% improvement in mortality in all hospitals, including those that have been under investigation. That is not to say that those hospitals should not be doing better, but he was talking about all hospitals.

[Andrew Gwynne (Denton and Reddish) (Lab)]

Professor Keogh’s report also shows that although mortality has dropped by 30% in all hospitals, it has dropped by between 30% and 50% in the 14 hospitals subject to the Keogh review. Although those hospitals are still outliers, the drop has been greater at those 14 hospitals.

[Derek Twigg]

My hon. Friend makes a strong and important point. I referred earlier to figures from the Library, but those figures are from the NHS. Just to repeat, the rate of deaths per 100,000 within 30 days of a non-elective hospital procedure in England was 4,850 in 2001-02 and 3,684 in 2010-11. That is a significant drop, so I hope the Secretary of State will correct the record, change his view that there was a “slight” improvement and confirm that it was a significant improvement, because that is what the evidence from his own Department says. Why is that important? It is important for a number of reasons. It is important to see improvements, but we should also bear in mind that the fall from 2001 took place against a massive increase—4 million additional admissions—in the number of people admitted to hospital. It is also important because people want to see continual improvements and be assured that their relatives and friends are receiving the best possible treatment.

In the short time I have available, I want to talk about a couple of local issues. Staffing plays a fundamental part in regard to risk. Many hospitals are having real difficulty with staffing at the moment, and many more will do so. I will say more about that in the context of my own hospital in a second. We need to address the problem, and the mix of staff is also a factor.

The Warrington and Halton Hospitals NHS Foundation Trust serves my constituency. We have been told by the chief executive and the chair of the board of governors that our hospital will run out of money in about 18 months’ time. It has already had to make savings in staff numbers of about 200, and implement a £7 million cut. The hospital will be unsustainable in that situation. What are the Government going to do about that? It is a foundation trust, and as far as I am aware, there are no significant performance issues. I get complaints about the different hospitals, but it is no worse than any of the others. It will run out of money, however.

My hon. Friend the Member for St Helens North (Mr Watts) has mentioned the St Helens and Knowsley NHS Trust. The Whiston hospital was rebuilt under Labour’s plan to rebuild hospitals. We replaced Victorian hospitals—and workhouses, as in the case of the Whiston—with more than 100 new hospitals. The deal on the Whiston hospital under Labour involved a private finance initiative, with the difference being paid for by the two primary care trusts. This Government have got rid of the PCTs, but they have still not put in place a way of funding the hospital on a long-term basis. The uncertainty continues, despite debates on the matter in this place and meetings with Ministers, and we still do not know what is going to happen. It is an excellent hospital with brand-new facilities, but it is facing a real challenge. We need the Government to make decisions about hospital funding, to ensure that it and others can continue; otherwise, many more hospitals will get into difficulty.