Health Inequalities

Anne Marie Morris Excerpts

Wednesday 4th March 2020 Commons Chamber

[Anne Marie Morris (Newton Abbot) (Con)]

Good health and good healthcare are clearly the basis for happiness and prosperity for individuals and communities. As we have heard, many factors impact on health: some are personal and genetic; some are life circumstances, such as deprivation; and some are about the quantity and quality of health and care provision. But when this all comes together, we have a perfect storm. That is the plight of those who live in rural communities; my hon. Friend the Member for St Ives (Derek Thomas) alluded to that. Yet the 170-page Marmot report mentions the word “rural” only seven times, of which four are references to the Department for Environment, Food and Rural Affairs. So what do we mean by rural? It is interesting. It is not consistently defined. The Office for National Statistics, DEFRA and the Welsh Assembly all have different definitions. They are based on sparsity and deprivation, but they do not really look at the same thing. What is worse, data is analysed at a very high level. The cut-off is 15,000 heads of population. That really is not granular enough.

Density profiles look at rural towns, villages, hamlets and so on. The way they are built up, in blocks of population of 1,500, again does not really cut it. We have bizarre situations where High Peak is deemed only 55% rural, despite being right next to a national park, yet Sevenoaks, which I always thought was a big town, is 70% rural. It is very odd indeed. So there is a huge mask in the data in terms of what really is deprivation and where the need is. Therefore, the funding that is delivered to rural communities, certainly in areas such as mine, is based on the wrong assumptions. In calculating whether my constituents need money, there is a decision: do they have cars? Yes. That means they are affluent and do not need the money—wrong.

[Dr Luke Evans (Bosworth) (Con)]

Does my hon. Friend agree that patient behaviour around rurality is different from those in the city? They have to make a decision when they are on their own whether to trouble the GP, to go out, to face the weather, to go to the hospital. When they really need to go, they leave it to the last minute. That creates an inequality that is not captured in the data.

[Anne Marie Morris]

My hon. Friend is totally right. There are some very big consequentials relating to the geography of our area and to the demographic profile. We tend to export young people and import older people. In consequence, we need more geriatricians. We do not need a lot of specialists; we need doctors who can cope with complex co-morbidities. We do not have doctors like that.

We need also more funding for primary care. Much of the funding is skewed towards accident and emergency. Why? Because that is where the measures are. We also need to look at how we overcome the infrastructure barriers. Road and rail, bad; 5G, great. But we do not have it. We ought to be a priority because that would be a real plus in trying to solve this rural problem.

We also need to train and recruit people who understand rural communities. If we do not train them in rural areas, they will not want to come and stay. Nurses working in hospitals and in social care need to be trained in a similar way and they need to be interchangeable, otherwise we cannot cope with the demand in social care. On mental health, as I think has already been mentioned, isolation and loneliness in rural areas mean that we have a very high level—I think the highest level—of suicide. We have lots of lone workers and lone livers. That is a real challenge.

The consequence of all that is that in Devon we find ourselves with some of the worst financial performance results and some of the worst results in terms of meeting targets. Why? Because we are being funded for the wrong thing in the wrong way. Nobody seems to notice that many in our community do not ever get ambulances. You try north Devon and parts of Cornwall—it is just not going to happen. The effect is that we are now in special measures. What does that do? Do we get help? Actually we get told to spend less. If that is not health inequality, I do not know what is. I hope the Minister will not tell me that people in rural areas live longer. It is not great to live longer if you are not in great health and the quality of your health really does not cut it.

This situation can change and it has to change. The Government need to accept that one size does not fit all. If the Government are willing to listen and to change, it can all happen.

I invite the Minister to come and listen to the evidence I am gathering while chairing a national inquiry into rural health and care. We are unpicking the issues. We are looking at evidence not only from across the United Kingdom, but from abroad—from New Zealand, Australia and America—of what good care looks like. We hope to provide the Minister with a toolkit for a good result. Thank you for listening.

[Several hon. Members rose—]