Government Vision on Prevention

Baroness Thornton Excerpts

Tuesday 6th November 2018 Lords Chamber

[Baroness Thornton (Lab)]

I thank the Minister for repeating the Statement and I welcome his remarks on the use of medicinal cannabis. I also welcome his comments on the appalling, barbaric abuses of those with learning disabilities and autism. Indeed, my honourable friend Barbara Keeley MP is raising that issue in the Commons right now, as the noble Lord is probably aware, and is asking, as I am, for further information about how to end the long-term seclusion and how to deal with the deaths of autistic people and people with learning difficulties. Everyone is shocked by what we have learned about what has been happening in our hospitals and in these units. Is it now time that these institutions were either closed or completely changed?

I am pleased that the new Secretary of State has discovered at this early stage in his career that prevention is better than cure. I certainly welcome the emphasis and focus on prevention. But as the saying goes, “Fine words butter no parsnips”—although in the case of public health perhaps we should not be buttering anything anyway. In other words, the new Secretary of State and his enthusiasm for prevention can be judged only by actions and results. In that context, he is starting, I am afraid, with some dismal facts that he has to overcome to achieve his ambitions.

The first of those is the £700 million-worth of cuts to public health services, with more cuts to those services being pencilled in for the next year, including £17 million of cuts to sexual health services, £34 million of cuts to drug and alcohol services, £3 million of cuts to smoking cessation services and £1 million of cuts to obesity services. As noble Lords will be aware because it is something that has been mentioned in the House for many years, every single pound spent on prevention provides £14-worth of social benefit. This is not a sensible economic decision.

In the context of obesity, when do the Government plan to outlaw or ban the advertising of junk food on family television as part of the drive to tackle childhood obesity? Immunisation for children has fallen for the fourth year in a row, so a big part of prevention surely has to be a focus on investment in children’s and early years health services. However, health visitor numbers have fallen by more than 2,000, school nurse numbers have gone down by 700 and 11% of babies miss out on mandated health checks. My first question about the prevention programme is this: what are the Government’s plans to reverse these cuts, particularly of health visitors and school nurses?

Yesterday, the Association of Directors of Public Health said that the spending review should allocate an extra £3.2 billion for the public health grant next year. Does the noble Lord accept that figure? As we all know, prevention is not just about public health, as he has said—it is also about social determinants, jobs and housing being the most obvious. According to research by Sir Michael Marmot, the world-recognised authority on public health, improvements to life expectancy have stalled since 2010 and inequality is widening. There is now a life expectancy gap of 13 years between women living in the poorest and the richest parts of the country. Does the noble Lord agree that deficiencies in the funding of our health and social care system along with the availability of resources to provide prevention services are key to this?

Prevention also concerns the availability of, and access to, primary care. GP numbers are now down by 1,000 since 2015, and as I have said, since 2010 district nurse numbers have been cut by 3,000. People with serious mental health problems die on average between nine and 20 years earlier than others. This is one of the starkest inequalities in our country. One in four adults and one in 10 children will experience mental health illness. On social care, some of the most disadvantaged in our communities are the elderly and the disabled. If the Secretary of State intends to lead a drive for better health in later life, how can that be achieved without addressing the parlous state of social care in many areas?

Can I seek clarification from the Minister about the different strategies and Green Papers that are in play at the moment? Is the recent announcement part of the 10-year strategy that is to be drawn up before Christmas, is it separate from that or is it in addition? How is this linked to what seems to be the Green Paper on social care that never arrives? We were promised a national plan after the Budget, hotly followed by a Green Paper, while yesterday the Minister talked about a prevention plan “next year”. I confess myself to be confused because if we add to that the fact that there is a commitment to transform mental health services by 2020, the Minister needs to clarify for the House how all of these are going to be integrated and in what order we can expect them to appear.

We welcome a focus on prevention and we have long called for it. However, a genuine commitment to prevention must start by reversing the public health cuts that we can see before us at the moment because on that basis, I fear that the parsnips really are not going to be buttered.