Health Inequalities: Office for Health Improvement and Disparities

Debbie Abrahams Excerpts

Wednesday 26th January 2022 Westminster Hall

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

I will keep my mask on because I have a wound, unfortunately, which I need to keep covered. It is an absolute pleasure to serve under your chairmanship, Mr Twigg. I remember that we served on the 2012 Health and Social Care Bill Committee together, so this is bringing back memories.

I congratulate my hon. Friend the Member for Bootle (Peter Dowd) on his excellent speech, and particularly on his focus on the wider health determinants and the need for an intergovernmental strategy and co-ordination. He is absolutely right.

I sought to become an MP because of my work on health inequalities. I was at the University of Liverpool for 10 years. Prior to that, I was a jobbing public health consultant. My hon. Friend mentioned the Black report. We must not forget that Margaret Whitehead at Liverpool was the first person to identify the health divide between the north and south. I am grateful to her. I learned so much under her and my other colleagues at Liverpool.

In the time that you have made available to me, Mr Twigg, I want to make three points. First, health inequalities are not inevitable. We hear “Oh, it’s always been there; it’s never going to change”. They are not inevitable but a consequence of political choices. As my hon. Friend said, those choices relate to whether or not we want socioeconomic inequalities to continue. It is also about—and this is rarely talked about—inequalities in power. We must ensure that that is addressed and brought into the debate.

Secondly, the structural inequalities across our country have been exposed and exacerbated by covid, resulting in, as Professor Sir Michael Marmot has said,

“the high and unequal death toll from COVID-19”,

which was one of the highest in the world. Thirdly, tackling health inequalities involves every single Government Department, not just the Department of Health and Social Care.

The term “health inequalities” refers to the increasing mortality and morbidity that occurs with declining socioeconomic conditions. In my Oldham East and Saddleworth constituency, the health inequality gap is more than 12 years. Those health inequalities are systematic and socially produced, and are a result of the differential distribution of income, wealth, knowledge, social status and connections. There is overwhelming evidence that those factors are the key determinants of health inequalities, influenced by written and unwritten rules and laws across our society, rather than biological and behavioural differences. I have always been disappointed by the focus always being on the individual: “It’s your fault if you get ill; it’s your fault if you get a disease. It’s your lifestyle choices.” It is not. There is overwhelming evidence on that.

There is no law of nature that decrees that the risk of a baby dying is 94% higher for children born into poor families than for those born into rich families, but that is the reality. We know that infant mortality, which had been declining for nearly a century, has started to rise again. As my hon. Friend has said, there are consequences to inequality and the austerity that has been imposed on so many families.

To my first point, given that health inequalities are socially produced, there is hope because that means that they are not fixed or inevitable—we can do something about them. If the Government are committed to levelling up, will the Minister comment on why the Gini coefficient has increased over the past few years? As my dear friend Frank Dobson famously said, nothing could be more unjust than someone knowing that they are going to die sooner because they are poor. Will the Minister comment on the socioeconomic factors that are driving health inequalities? Why they have they got worse over the past two years?

On my second point, Sir Michael Marmot was very clear in his analysis of the covid death rate that there have been four drivers of the high and unequal death toll in the UK: the governance and political culture detrimentally affecting social cohesion and inclusivity; the widening inequalities in power, money and resources; the regressive austerity policies over the past decade; and the declining healthy life expectancy of the poorest, particularly women, which is among the worst of all comparable economies. Deprived communities have also been hit particularly hard in that regard.

On my third point, as important our NHS is in treating and caring for us when we get ill, reducing inequalities must involve all Government Departments, as my hon. Friend has said. That was reflected in Sir Michael’s recommendations to address those inequalities. He said that we must build back fairer from the pandemic, with multi-sector action from all levels of Government, and increase investment in public health. Since 2015, there has been a 24% cut in public health budgets.

One thing we know about the NHS and its impact on inequalities relates to the privatisation and marketisation of health services. We know that that helps to reduce access to health services for those on lower socioeconomic groups. On top of that, there is the inequality in health outcomes. I fear that the 2021 Health and Care Bill will make a bad situation even worse, adding to the issues resulting from the Health and Social Care Act 2012.

Not only do countries in which there is a narrow gap between rich and poor have high life expectancy; they also have better educational attainment, social mobility and trust, lower crime and a fairer society as a whole. I appreciate that I have gone over time and apologise for that.

--- Later in debate ---

[Debbie Abrahams]

I refer back to my point about not victim blaming, but in relation to the NHS resource allocation formula, can I ask the Minister whether the Government will be reinstating the health inequalities weighting that the previous Administration scrapped?

[Maggie Throup]

If I may, I will write to the hon. Lady on that so I can make sure that my facts are completely clear, rather than giving her an answer that may not be quite accurate.

In recognition of the strong relationship between work and health, the joint work and health unit was established in 2015. It has invested in a programme of trials and tests to identify effective models of health and employment support, and it is now using that learning to develop and/or roll out services to support disabled people and people with long-term health conditions to enter and stay in employment. The 2021 spending review confirmed that the public health grant will be maintained in real terms for the spending review period, so local councils can continue to invest in prevention and essential public health services. The distribution of that grant is heavily weighted towards the areas that face the greatest population health challenges, with per capita funding almost 2.5 times greater for the most deprived authorities than for the least deprived. The allocation at local authority level will be announced shortly.

The role that local authorities play in improving public health is far broader than simply the important services and interventions funded through the public health grant. That grant is part of a wider package of targeted investment in improving the public’s health over the spending review period, including £300 million to tackle obesity; £170 million to improve the “best start in life” offer available to families, including breastfeeding advice and parent-infant mental health support; and an additional £560 million to support improvements in the quality and capacity of drug and alcohol treatment, which was announced as part of the drugs strategy. In addition, we have made over £12 billion available to local councils since the start of the pandemic to address the costs and impacts of covid-19. Of this money, £6 billion was non-ringfenced, because we recognise that local authorities are best placed to decide how to manage the major covid-19 pressures in their local areas.

Covid-19 Update

Debbie Abrahams Excerpts

Wednesday 8th December 2021 Commons Chamber

[Sajid Javid]

My hon. Friend is absolutely right that South Africa has a much lower level of vaccination—I believe it is around 25%—but there are other differences between South Africa and the UK, including that the vast majority of South Africans have antibodies against covid through infection. Not only do they have antibodies through infection, but a huge number of South Africans have antibodies through infection from the beta variant. It is important to know that the beta variant is much closer to the omicron variant, and it is quite possible that it might be giving an even higher degree of protection than people have in countries such as the UK, with vaccination against the Wuhan strain.

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

I welcome a precautionary response given the emerging data. By introducing these measures to slow down the doubling of the rate from two to three days to five to six days, we will enable more people to get vaccinated, which is very important. Will the Secretary of State authorise the immediate roll-out of the directors of public health float stock PCR pilot to help tackle omicron clusters before they become significant outbreaks?

[Sajid Javid]

I am pleased that the hon. Lady welcomes these measures, which will certainly help to slow down the growth of omicron. I will look at the measure that she referred to.

Covid-19 Update

Debbie Abrahams Excerpts

Monday 29th November 2021 Commons Chamber

[Sajid Javid]

My hon. Friend is right to raise the importance of vaccine delivery mechanisms. If there was an approved nasal vaccine delivery mechanism, it would be helpful. He will understand that we have to allow the regulators the time to assess new delivery mechanisms, but we do take this very seriously.

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

I wholeheartedly agree that no one is safe until we are all safe, and the UK and other G7 countries need to take some responsibility for the emergence of this variant. I just wanted to touch on the fact that we already have community spread of this variant. If we are to contain it, we must ensure that contact tracing is relevant and as widespread as possible. Can the Secretary of State confirm—I have asked him about this in the last few weeks—that the contain outbreak management fund will be extended beyond March; that those places that do not have it will have it; and that those that have already spent it will be properly resourced?

[Sajid Javid]

The hon. Lady makes an important point about contact tracing. On the contain outbreak management fund, especially given the emergence of this variant, we are actively reviewing it.

Oral Answers to Questions

Debbie Abrahams Excerpts

Tuesday 23rd November 2021 Commons Chamber

[Sajid Javid]

I agree that we want more and more full-time doctors, which will mean that there is less demand for locums and is, of course, very good for the NHS. I also agree that there should be more focus on the workforce, and I hope that my right hon. Friend welcomes the measure that I took yesterday of merging Health Education England with the NHS, so that we can have a much more joined-up workforce plan.

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

Andrew Dilnot, whose commission undertook the inquiry into social care nearly 10 years ago, says that the impact of the Government’s social care plans on working-age disabled people will be “catastrophic”. What is the Government’s assessment of the impact?

[Sajid Javid]

The hon. Lady is right to raise the importance of doing everything we can to look after working-age people who need social care. As she will know, the total funding of social care from the state now constitutes most of the funding, and it is right that all needs are met through those funds. As for the new plan, everyone will benefit—no one will lose out from this versus the current system—so the vast majority of people will be better off, including working-age adults.

Randox Covid Contracts

Debbie Abrahams Excerpts

Wednesday 17th November 2021 Commons Chamber

[Gillian Keegan]

Let me just finish this point and then I will give way, because I am sure that the hon. Gentleman is listening carefully and wants to hear these words.

Hon. Members will be aware that we have established an independent public inquiry that will begin work in the spring, with full powers under the Inquiries Act 2005, including the ability to compel the production of all relevant materials. We expect that the inquiry will be a valuable opportunity for us all.

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

May I just correct a couple of things that the Minister has said? First, Exercise Cygnus and Exercise Alice both identified shortages of PPE should there be a global pandemic, although it was never a question of if; it was always a question of when. Secondly, on the procurement disaster, the Minister should not forget that the Government were found to have acted unlawfully in the publication of their contracts in the action that I took with the Good Law Project and other hon. Members.

[Gillian Keegan]

I said that I would also give way to the hon. Member for Warwick and Leamington (Matt Western).

Covid-19 Update

Debbie Abrahams Excerpts

Monday 15th November 2021 Commons Chamber

[Sajid Javid]

My hon. Friend will not be surprised to hear that we work very closely with our colleagues in the Department for Education, especially with regard to that particular age group. The issue on asymptomatic testing is something we keep under review and, as soon as we can remove that, we will.

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

I want to pass on my thanks to the NHS and all its staff for all that they are doing on the covid vaccination programme. I particularly want to thank my local public health team, who called me after I contracted covid 10 days ago. They were incredibly supportive and thorough, which contrasted with the national team, who put the phone down on me; they expected me to pick up after one ring, which I did, but they put the phone down on me. Is the Health Secretary aware that the national Test and Trace team are expecting the local public health department to pick up the slack during the Christmas holidays as that team go on holiday—the public health department is going to have to pick up the slack when they are not doing their job?

[Sajid Javid]

The hon. Lady, like so many in this House, is right to point out the phenomenal work the NHS has been doing, particularly on the vaccination programme, the work NHS Test and Trace does and the work of the UK Health Security Agency on the testing programme.

Covid-19 Update

Debbie Abrahams Excerpts

Thursday 21st October 2021 Commons Chamber

[Maggie Throup]

The school age immunisation service has done a good job in getting through lots and lots of students in different schools. My hon. Friend asks about how we can speed it up, and that is why we are providing opportunities for parents to take their children to the vaccination centres by booking through the national booking service, which will provide further choice over the coming days, weeks and months.

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

I think it is very unfair of the Health Secretary to put the Minister in the position of having to deliver this statement on his behalf, but we are where we are. Given that the British Medical Association, the NHS Confederation and the Academy of Medical Royal Colleges have all expressed concern about where we are, can she give an update on the Health Secretary’s response to me on Tuesday, which was woeful, regarding what we are going to do about public health, given that the public health budget is 24% lower than in 2015 and given the demands that will be placed on public health, for example in outbreak areas, such as Suffolk? If she can provide me with an update, I would be very grateful.

[Maggie Throup]

I reassure the hon. Lady that we look regularly at all the data, particularly the covid data. If we feel it is necessary, we put enhanced measures in place. A number of colleagues in the House will have experienced that. It works really well. Obviously, we have the Budget and the spending review coming up shortly, and I am sure she eagerly awaits what will be in them.

Oral Answers to Questions

Debbie Abrahams Excerpts

Tuesday 19th October 2021 Commons Chamber

[Sajid Javid]

My right hon. Friend speaks with real experience, especially on tough winters for the NHS, and he highlights shortages across the NHS. He mentions 999 callers. There is a huge pressure at the moment on 111 calls as well, and emergency care generally, including ambulance services. A significant amount of support has been put in, especially over the past few months, with additional funding. We will set out a detailed plan with the NHS, coming shortly in the next couple of weeks, on exactly what more we will be doing.

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

Given the high covid infection rates and the risk of new variants of concern emerging that may be vaccine-resistant, what discussion has the Health Secretary had with the Chancellor on extending the contain outbreak management fund and on increasing public health budgets, which are 24% lower than they were in 2015?

[Sajid Javid]

The hon. Lady will know that in terms of the pandemic we are very focused on vaccinations, treatments and testing. She is right to raise the importance of testing and surveillance for possible new variants. That remains a priority for the Government and it is getting the support it needs from the Treasury.

Health and Social Care

Debbie Abrahams Excerpts

Wednesday 21st July 2021 Ministerial Corrections

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

Many of my former public health colleagues are very concerned about lifting mitigations today in the context of escalating cases—50,000 currently—12 million people who have not been vaccinated and an NHS and care workforce who are frankly on their knees. What estimates have the Government made of the effect of extending the wearing of masks and other mitigations three weeks after 80% of the eligible population have been vaccinated on incidence of long covid, hospitalisations and deaths?

[Nadhim Zahawi]

The vaccination programme could in no way have delivered the extraordinary uptake without the backbone being NHS doctors, nurses and pharmacists, working with our armed forces, local government and the private sector to deliver it.

Covid-19 Update

Debbie Abrahams Excerpts

Monday 19th July 2021 Commons Chamber

[Nadhim Zahawi]

My right hon. Friend is right that there is no such thing as a wrong batch of Oxford-AstraZeneca vaccine in the United Kingdom. Our independent regulator regulates all manufacturing sites for AstraZeneca, Pfizer and the other vaccines. The AstraZeneca vaccine produced in the Serum Institute is the same vaccine—the Vaxzevria vaccine brand that is approved by the MHRA and the European Medicines Agency. There was some confusion in parts of world such as Malta last week, which the MHRA, the EMA and the Commission helped to clear up. I reassure my right hon. Friend that anyone who has had an Oxford-AstraZeneca vaccine and has the UK app or the letter to demonstrate their vaccination can travel. I think that 33 countries now recognise our vaccine certification.

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

Many of my former public health colleagues are very concerned about lifting mitigations today in the context of escalating cases—50,000 currently—12 million people who have not been vaccinated and an NHS and care workforce who are frankly on their knees. What estimates have the Government made of the effect of extending the wearing of masks and other mitigations three weeks after 80% of the eligible population have been vaccinated on incidence of long covid, hospitalisations and deaths?

[Nadhim Zahawi]

The vaccination programme could in no way have delivered the extraordinary uptake without the backbone being NHS doctors, nurses and pharmacists, working with our armed forces, local government and the private sector to deliver it.