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.