Finance Bill

Debbie Abrahams Excerpts

Report stage
Monday 5th February 2024 Commons Chamber

[Debbie Abrahams (Oldham East and Saddleworth) (Lab)]

May I ask colleagues in all parts of the House for some indulgence? Unfortunately, I was missed out on Report, but I very much wanted to speak about new clause 4, which I tabled. It is very close to my heart, and it is the reason why I became an MP. Specifically, it is about asking the Government to make an assessment of the public health effects of the Bill, particularly in terms of regional inequalities, the impacts on protected characteristics and the impact on the NHS.

I would first like to associate myself with the comments of my hon. Friend the Member for Ealing North (James Murray) about His Majesty King Charles. I wish him a very speedy recovery, and send best wishes to his family.

I had hoped that I might convince the Minister just a little more than I did in Committee about what a difference the assessment in my new clause would make. I am going to extend the arguments just a little more, if he will bear with me. I appreciate that I cannot do anything about the issue in this Bill, but perhaps he could think about it for the one we will have after the Budget, because I will be returning to this issue again. The proposal is not about changing anything in the Finance Bill; it is about publishing the Government’s evaluation of the impact of their policies, as announced in the autumn statement, on the health of our constituents as mediated through, for example, changes in poverty and socioeconomic inequalities. Ideally, that would have been done during the planning of the autumn statement, but given that that did not happen, my new clause would have provided the opportunity to make decisions based on an evaluation of the impacts on our health, including our children’s health.

Many Members will have heard about and read the report of the Academy of Medical Sciences on child health, which came out earlier today. In it, the UK has been revealed to have a stalling infant mortality rate, which is worse than 60% of that in similar countries. This is after a century during which infant mortality has been decreasing. The academy has put to us, as decision makers, that we need to be doing a lot better. My new clause would have helped the Government in their quest for transparency, fulfilling the Prime Minister’s promise on that, and restoring confidence in the Government and in politics more widely. It would also have allowed the Government to monitor their commitment to levelling up our health across the country and to tackling the appalling north-south divide.

I was director of public health research at the University of Liverpool along with Professor Dame Margaret Whitehead, who in 1987 published her report revealing for the first time the north-south health divide. It came out a few years after the Black report and it showed the causal relationship between poverty and health. Margaret took it a step further, emphasising socioeconomic inequalities, not just poverty, as the key driver of these health inequalities.

We have been building on that evidence base for the past 40 years or so. Many will have read “The Spirit Level” by Professors Richard Wilkinson and Kate Pickett which showed the universal relationship between socioeconomic inequality and educational attainment, social mobility, trust between communities—where has trust gone within our communities?—reducing crime and much more. The narrower the gap in socioeconomic inequalities, the better almost all societies across the world do on a whole host of measures including health and wellbeing.

Professor Sir Michael Marmot’s 2010 totemic “Fair Society, Healthy Lives” report set out six objectives across our life course of what we as a country need to do to address these socioeconomic inequalities and reduce health inequalities. He warned us in 2017 when we started to see life expectancy in England as a whole flatlining, which was accompanied by declining healthy life expectancy. We heard many questions in today’s Department for Work and Pensions orals about what we can do to get a fit and healthy labour force, and our inequalities are partly why we are in our current position. Professor Marmot also revealed that life expectancy for the poorest women and in the poorest areas was declining, and that we were one of three advanced economies in the world where this had been happening, along with the USA and Iceland. This is not a question of our having reached peak life expectancy; we are falling behind most of our competitors. He also revealed that health inequalities had increased and that there was an even starker north-south health divide.

Then covid hit. The same pattern of infection, ill health and death was seen with covid as was seen before the pandemic with other conditions. The same groups of people and the same areas were affected by covid as were affected by, for example, heart disease.

Last month Michael provided another update in his latest report, “Health Inequalities, Lives Cut Short”. He said in The BMJ a couple of weeks ago something that I asked the Prime Minister about last week:

“if everyone had the good health of the least deprived 10% of the population, there would have been 1 million fewer deaths in England in the period 2012 to 2019. Of these, 148,000 can be linked to austerity. In 2020, the first year of the covid pandemic, there were a further 28,000 excess deaths.”

Today, I see no evidence that policymakers have learned from or even understand this injustice, or its economic consequences. I urge them to watch a short film, “The Unequal Pandemic”, which shows the human cost of this inaction. Our experience of covid and these inequalities is not inevitable.

Today’s Academy of Medical Sciences report estimates that a cost of £16.13 billion a year could have been avoided by early childhood intervention. The relationship between population health and productivity is also well established. In its 2018 “Health for Wealth” report, the Northern Health Science Alliance argued that in order to improve our productivity and growth we must improve our health. It calculated that improving the health of the north to the level of the rest of England would increase productivity by £13.2 billion a year. It is in the economy’s and the Chancellor’s interest to undertake this health assessment of his measures. I appreciate that that is not going to happen in this Bill, but I would be grateful if the Minister would consider it for the next one.

I was grateful in the Finance Bill Committee for the Minister responding with a long list of data that the Government already collect on poverty, and so on. Unfortunately, he did not explain how these data were then analysed to assess the impact of his Government’s measures on, for instance, stricter social security sanctions, and how those would affect the current levels of children living in poverty, deep poverty and destitution, as described in the Joseph Rowntree Foundation “UK Poverty 2024” report. He did not explain if these data had been disaggregated to examine the impacts of these policies on different parts of the country, on disabled people or on people from ethnic minority communities, and he did not explain what scenario-modelling on poverty, deep poverty and destitution had been undertaken to understand whether more children will die before their first birthday because they had been born into a poor or destitute family. For each 1% increase in child poverty, an extra 5.8 babies per 100,000 livebirths will die before their first birthday.

Professor Sir Michael Marmot has asked us to provide hope—hope that we as politicians can recognise and understand that these inequalities must be addressed and that they are not inevitable, and I agree. I urge the Minister to really consider this, if not now, then in the next Finance Bill, and to come back with a set of proposals on how the Government are going to do it.

Question put, That the Bill be now read the Third time.