The National Health Service

Debbie Abrahams Excerpts

Wednesday 23rd October 2019 Commons Chamber

[Jonathan Ashworth]

No they don’t; none of the hospitals the right hon. Gentleman announced at the Tory party conference includes mental health trusts. He knows there are 1,000 beds in old-style dormitory-style wards in desperate need of upgrade. He knows that we have problems with anti-ligature works that desperately need doing in mental health trusts because they are putting lives at risk every day.

On social care, we were told we were going to have the big solution to social care. The Secretary of State was briefing that a previous Chancellor, the right hon. Member for Runnymede and Weybridge (Mr Hammond), was holding him back and he was going to give us a solution on social care. And what do the Government say? They say, “We have not got a social care Green Paper, we have not got social care proposals, we will get proposals on social care in due course.” The Secretary of State is kicking the can on social care down the road again.

Let me come to the Health and Social Care Act 2012. On Second Reading, it was described by the new Minister, the hon. Member for Mid Bedfordshire (Ms Dorries)—I welcome her to her elevation to the Treasury Bench; it was remiss of me not to do that earlier—as one of the most exciting Bills to be put before Parliament in the 62 years since the NHS was established. We were told that there was going to be legislation to undo the worst excesses of that Lansley Act, but all we are getting apparently is draft legislation, again, “in due course”—that is the wording in the explanatory notes to the Queen’s Speech.

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

I had the privilege of sitting on both Committees that considered the Health and Social Care Bill, as it was then. Section 75 is particularly punitive in terms of its requirements for clinical commissioning groups to put all contracts out to tender. Some £25 billion-worth of public money has gone to the private sector, with the implications of an increase in health inequality, both in access and outcomes. Does my hon. Friend agree that this is an absolute travesty?

[Jonathan Ashworth]

Absolutely.

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[Matt Hancock]

Yes, I can give that confirmation. I have seen some reports from the local Labour party putting fears into people’s minds about the future of the Parsons Green walk-in centre. There are no plans to close the centre, and anybody who says so is simply scaremongering. I am absolutely delighted at the campaign that my right hon. Friend ran to save the A&E and to save the services in west London; it was thanks to him and his efforts that we managed to do exactly that.

[Debbie Abrahams]

Does the Health Secretary not feel ashamed that we have the highest rate of child mortality in western Europe? We also have a declining life expectancy; for women it is getting worse and for deprived areas it is getting worse. We are one of the only developed countries where that is happening, and it is partly as a result of the underfunding of the NHS but more widely because of austerity.

[Matt Hancock]

I have great regard for the campaigning that the hon. Lady does on many topics, but I am afraid to say that she was factually inaccurate in what she said just now; it is not true. We are putting the largest and longest investment into the NHS in its history, and I think that that is the right thing to do.

Mental Health Act 1983

Debbie Abrahams Excerpts

Thursday 25th July 2019 Westminster Hall

[Neil Coyle]

I completely agree. Sadly, the figure for people with schizophrenia in work remains at about 5%. It is just 5%, because the support simply is not there and the medication and treatment are not there on a routine basis to ensure that they are able to work.

Figures suggest that one in four of us will experience mental ill health at some point in life, often because of bereavement or a relationship breakdown. I pay tribute to all the organisations involved in the Time To Change campaign, which has done brilliant work to challenge the stigma and discrimination that affect people with mental health conditions in employment and elsewhere.

The change in language and awareness of conditions is one reason to seek reform now. For example, the Mental Health Act 1983 is defined as:

“An Act to consolidate the law relating to mentally disordered persons.”

The language around mental health has changed much since the current law was enacted. We also need to consider its far reaching powers.

The independent review of the Mental Health Act, published seven months ago concluded:

“The Mental Health Act gives the state what are amongst the most significant powers that it has; the power to take away someone’s liberty without the commission of a criminal offence and the power to treat that person even in the face of their refusal. Because of that, we think that is important that the purpose of the powers is clear, as should be the basis on which they should be used.”

It is hard to disagree with that conclusion, especially given the number of people who are affected by those extensive powers.

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

I congratulate my hon. Friend on securing this debate, and on his personal and emotional contribution—I believe that adds everything. People living with dementia also fall under the Mental Health Act. There are concerns around section 117 and the right for aftercare support once someone is detained under the Mental Health Act, particularly those living with dementia. Does my hon. Friend share my concerns on that?

[Neil Coyle]

Certainly, there is insufficient support for a whole range of people. We have sadly seen a roll-back of support, independence of choice and control in a number of areas, including social care support, health services and direct benefits for some disabled people, particularly in the past nine years.

The extensive powers, which I described, were used to detain 50,000 people last year—a 47% increase in the past decade. The only other people detained in this country are those in criminal custody. Those citizens have safeguards to protect them from going to jail, but we do not have the same safe standards of support and safeguards for mental health care. Those who commit a criminal offence have a police investigation, the CPS evidence threshold, a trial, the right of appeal and advocacy throughout, but for the 50,000 detained under the Mental Health Act few such safeguards exist, despite the deprivation of liberty, choice and control.

We can turn this situation around. The independent review of the Mental Health Act, chaired by Professor Sir Simon Wessely, recommended that four principles be written into a revised Act. First, it recommended that choice and autonomy, even for someone detained under the Act, must be respected, enabled and enhanced wherever possible. Secondly, it recommended that the compulsory powers contained within the Act should be exercised in the least restrictive way possible. Thirdly, it recommended that services and treatments should be of therapeutic benefit and delivered with a view to minimising the need for Mental Health Act powers to be used. Fourthly, it recommended that the individual must be respected, and that care and treatment must be provided in a manner that treats them accordingly.

I seek the Minister’s views on those principles being incorporated in forthcoming plans. If those four principles had existed when my mum was detained—she has been sectioned more times in my lifetime than I can remember—I would have had more reassurance that her needs, rights and wishes would have been the starting point for the care and treatment she received. Sadly, that was not the case.

This is the first debate to be held on the Mental Health Act since that review was published, which is astonishing, given the level of use of the powers in the Act and the level of support for reform. The review made 154 recommendations. The Government accepted two immediately and agreed to publish a White Paper by the end of this year to bring forward full legislation. I welcome that; there is no one who does not want to see that. However, given the paralysis caused by Brexit, and the new Prime Minister and Cabinet, can the Minister confirm that that timetable has not slipped?

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[Dr Lewis]

I am delighted to see the hon. Member for Bermondsey and Old Southwark indicating his agreement. It meant that they would not then suffer a much worse breakdown, which would have meant that they would have to be incarcerated, for want of a better word, for a much longer period.

[Debbie Abrahams]

To prevent people, including people living with dementia, from having to be admitted to hospital, there needs to be community support and after-care support once people are discharged, to ensure that they can be kept as healthy and independent as possible in the community for as long as possible.

[Dr Lewis]

The hon. Lady is absolutely right, as long as we recognise that what is needed is a range of facilities. Even the most ardent advocate of doing away with in-patient beds would, if pressed, admit that there will always be some people who at some point absolutely need to have some in-patient treatment.

If there are some people who need to go in for a considerable period of time, and hopefully there are a lot more people who do not need to be admitted to acute units at all, it follows almost logically that there will be some people who are on the borderline between the two, who can get by in society with a degree of self-awareness—either their own or that of their immediate family—and that when the warning signs appear, provided there is that network of specialist care with beds for very short-term stays, they can receive what I call a “top-up”, or, if we were talking about servicing a vehicle, something that will prevent a much greater collapse from happening later, with all the consequent horrors.

The question of what happens when people are admitted to acute units arose on a second occasion. I mentioned the first occasion, when I tried to introduce my private Member’s Bill in December 1997 and it was overshadowed by foxhunting. On a second occasion—on 9 December 2010, to be precise—I had secured an Adjournment debate on what happens about the information that is given to someone’s nearest and dearest when an adult is sectioned and goes into an acute unit. That occasion was on the day of the key debate about the trebling of student tuition fees, so once again we found mental health being somewhat upstaged by other matters that were of national importance. However, that is no reason not to persist or not to continue to try and emphasise to Ministers how these issues will never go away until they are finally tackled.

On that occasion in December 2010, I raised the case of the daughter of my constituents, Mr and Mrs Edgell. Sadly, their daughter—who was called Larissa but known as Lara—had taken her own life in 2006. For two years prior to that, the medical authorities had refused to share information about her with her parents; because she was an adult in her thirties, they refused to share vital information about her suicidal thoughts with her parents, on the grounds of patient confidentiality.

It subsequently turned out that there were very good guidelines that said that such information should be shared. So, I wrote to the then Minister with responsibility for care services, the hon. Member for Bury South (Mr Lewis), saying that there was clearly a breakdown in the system if adequate rules existed but were not being put into practice locally. The rather unsatisfactory answer that I received at the time was that the responsibility lay with the local medical authorities to ensure that the central guidelines were implemented.

As I say, that was at the end of 2010, so it was a long time ago. I wonder whether the Minister will be able to reassure me that there is now more central direction. In the case of Lara and her parents there was inadequate sharing of vital information, under the mistaken belief that patient confidentiality trumped the fact that an adult patient was incapable of making her own decisions. I would like to know whether that situation has been rectified, or whether we are still dependent on local medical institutions and authorities to apply a central guideline that ought to be better known.

This week, I received a letter from Lara’s mother, who asked me to attend this debate. I can do no better than to read from what she says, not so much about what happened to her daughter but about the continued interest that she has in the workings of the mental health services. She says that she would like to make her own recommendations; given what happened so tragically in her immediate family, we owe it to her to give serious consideration to those recommendations, which are as follows:

“1. The 1983 Act should be revised to prioritise the dignity of individuals who come to be in the Service’s orbit.

2. Such individuals should have their values and world views respected and have a significant say in the manner of their treatment.

3. They should have the option to refuse certain treatments.

4. Mental hospitals must be places where patients feel safe: there have been numerous allegations of staff members being abusive, provocative and/or intimidating.

5. Use of force should be absolutely minimised. This includes physical restraint, seclusion, or forced medication.

6. A reduction in ‘sectioning’.

7. A reduction in stigma”—

and finally:

“8. All aspects of the Mental Health Service should be more open, and subject to independent scrutiny from time to time.”

I will conclude by making one left-field observation relating to the armed forces. The Select Committee on Defence, which I have the honour of chairing, has been recommending for some time that we establish a centre of excellence for the mental injuries suffered by those who put their life on the line to defend this country, preferably alongside the national centre for physical rehabilitation at Stanford Hall. We have now raised this issue twice with the Secretary of State for Health and Social Care, who has given us a reasonably encouraging response. However, once again, we feel that he is coming up against resistance because of the philosophy that people must be treated locally when at all possible, not admitted as in-patients in centralised locations. That is causing a pushback against our idea.

Our idea is based on the fact that those who suffer injury in combat situations have experienced a peculiar and unique form of trauma, different from those that ordinary mental health professionals can be expected to understand. I am sure that my hon. and gallant Friend the Member for Plymouth, Moor View (Johnny Mercer) will want to expand on that topic, if he is lucky enough to catch the Chair’s eye. We believe that there is a case for a national centre of excellence, and that the welfare of members of our armed services who suffer mental injury should be no less important to us than the welfare of those who suffer other, physical forms of injury in the cause of defending our freedom.

Living with Dementia

Debbie Abrahams Excerpts

Tuesday 25th June 2019 Westminster Hall

[Ian Paisley (in the Chair)]

It is very warm in the Chamber today. Hon. Members may want to remove their jackets: please feel free to do so—I would not want anyone parboiled. Before I call Debbie Abrahams, who will move the motion in her own time, I ask Members to prepare, because of the interest in the debate, to make speeches of about five minutes. We shall keep that informal, but hopefully we will be able to get everyone in.

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

It is lovely to see you in the Chair, Mr Paisley. I thank the Backbench Business Committee, which granted the debate, and I want to recognise my hon. Friend the Member for Cambridge (Daniel Zeichner) as its co-sponsor. I also thank the Alzheimer’s Society, which provides superb support to the all-party parliamentary group on dementia, and the parliamentary digital team for promoting the debate. We hope to hear the views of many people from across the country on the recommendations in the report we shall discuss.

The subject of dementia and people living with dementia is particularly close to my heart. As many Members will know, my mum was diagnosed with Alzheimer’s disease at 64 and I was one of her principal carers. Having had that caring experience and seen some of the issues my mum faced, I wanted to raise awareness about dementia and the many different brain diseases that cause it. As many will know, dementia is now the leading cause of death in the UK, having overtaken heart disease and cancer. It is estimated that 850,000 people in the UK have a dementia, and Alzheimer’s disease is the most common. That is expected to increase to 2 million by 2050. Globally, there will be 152 million people living with dementia by 2050—a 204% increase. If there is anyone who does not now know someone with dementia, they soon will.

There is already much work under way at the UK Dementia Research Institute, where there is a search for programmes to identify people at risk of different dementia types and prevent them from contracting the disease, as well as for treatments and cures. In spite of the commitment by the former Prime Minister, David Cameron, to invest in dementia research, it still receives only one tenth of the research funding that cancer receives. However, there is also a need to invest in dementia research that could improve the lives of people affected by dementia today. I have campaigned with many others to raise the issues affecting people living with dementia, including becoming the first MP to be a Dementia Friends champion, working with Oldham Dementia Action Alliance to develop a dementia-friendly Oldham and Saddleworth, and undertaking various all-party group inquiries on how to improve the quality of life of people living with dementia.

The report from our latest inquiry, on dementia and disability, was launched last week. More than 2,500 people affected by dementia responded to our call for evidence—one of the largest responses to any all-party group inquiry. What the respondents had to say is very important. According to the Equality Act 2010 and the United Nations convention on the rights of persons with disabilities, dementia is a disability. As one family carer put it:

“If this isn’t a disability then I don’t know what is.”

However, the all-party group was told that society is lagging behind in that understanding and failing to uphold the legal rights of people with dementia. Evidence presented to the inquiry revealed that, across the country, the disability rights of people with dementia are not being upheld. Shockingly, 98% of the survey respondents thought that people living with dementia are treated differently from people with other health conditions or disabilities. They believe that that is due to the hidden nature of dementia, and the stigma that surrounds the condition. That is simply not good enough, and we need to do more.

[Mr Jim Cunningham (Coventry South) (Lab)]

I congratulate my hon. Friend on obtaining the debate, and those who supported her. I hope she will touch on the cost of care. The cost of looking after people with dementia is astronomical, as it is with care generally. I hope she will also touch on progress with dementia research.

[Debbie Abrahams]

I thank my hon. Friend, who anticipates me. I shall certainly talk about social care in relation to people living with dementia and their carers. My speech is focused on our inquiry report, but other hon. Members may want to touch on progress being made in research.

A central finding of the inquiry is that the public, employers, organisations, Governments and public bodies need to do more, and need to recognise the rights of people with dementia. The inquiry also revealed that a range of societal barriers prevents people with dementia from living independently. Action needs to be taken across a number of key areas to ensure that people with dementia receive the protections and safeguards provided by legislation and convention. The key areas that were identified as having a direct impact on people’s daily lives include employment, social protection, which is also called social security or welfare benefits—I consider that a misnomer because most people who receive so-called welfare benefits have contributed, so they are an entitlement, not a benefit—social care, transport, housing and community life.

On employment, the importance of work in giving people a sense of purpose, self-esteem, status, companionship and income was raised. Work can also provide a routine. Without it, people can feel a loss of identity and sense of purpose. One person with young onset dementia told us:

“I applied for so many jobs and I just got rejections. I used to lecture at a university and now I can’t get a job collecting trolleys. Any job is worthwhile. Not having a job destroys self-esteem.”

At the launch of the inquiry report last week we heard of a woman who had worked in a Government Department and had been diagnosed with early onset dementia. She became ill because of the condition, was then disciplined about that and, ultimately, was forced to take ill-health redundancy. I know that the Minister will be as concerned as I am about that disgraceful position. If Departments are setting out how we should lead, we must make sure we have our own house in order.

There needs to be more awareness among both employers and employees of the employment rights of people with dementia. People need to feel empowered to tell their employers about their diagnosis and employers should feel supported in fulfilling their responsibility to make reasonable adjustments so that people with dementia can continue to make a meaningful contribution in the workplace. The Government have a hugely important role to play, by providing guidance and support for employers. The Access to Work programme could go some way to addressing the unmet needs of people with dementia in relation to employment. However, as I know the Minister recognises, that is a small pot of money, which currently supports only about 35,000 of the 4 million or so disabled people who are fit and able to work. We need to make sure that that is extended.

In relation to social protection, people raised issues about the extra costs associated with living with a disability. Access to extra financial support can provide a lifeline for people with dementia and help people to continue getting out and doing the things they enjoy. One of the key challenges for people affected by dementia is knowing what financial support is available to them. One family member told the all-party group that they felt that

“people with dementia are effectively ignored by the disability benefits system.”

People with dementia and their carers need access to more support to enable them to know what financial help they are entitled to and how to make a successful claim. The Minister knows my views on both the fit-for-work and personal independence payment assessments. Until those assessments are scrapped, people with dementia deserve to be assessed by professionals who understand the condition, and they should not have to undergo unnecessary reviews or reassessments, as currently happens.

Assessment processes need to be clear and appropriate for people with cognitive impairments. That is why we are calling for the Government to mandate the Department for Work and Pensions to convene an expert group to review access to social protection for people living with dementia and their carers, recognising their specific needs. This group must include those who are experts by virtue of their own lived experience. The Government should also mandate the DWP to exempt personal independence payment claimants below the state pension age and with a dementia diagnosis from reassessments, which are unnecessary and cause a lot of distress for people living with dementia and their families.

A further key issue was social care. The inquiry received considerable feedback about inadequate or inaccessible social care for people affected by dementia living in England. There are many ways to improve the lives of people with dementia, but it is difficult in the current context of the well-documented social care crisis across the country. It is now recognised that that social care crisis is a dementia crisis. We need to fix the broken care system, and I am proud to support the Alzheimer’s Society’s “Fix Dementia Care” campaign. I know the Minister is eager to publish the Green Paper as soon as possible, and I urge the Government to recognise that.

In the context of social care reform, I will mention the Alzheimer’s Society’s campaign for a dementia fund. The system of dementia care in this country is in urgent need of reform and extra investment. In May, I tabled early-day motion 2360 in support of the campaign, calling for a financial injection into the social care system in the short to medium term, allowing for greater provision of safe and quality care, longer visits and savings to the NHS. My EDM now has the backing of more than 100 MPs of all parties, and I know that thousands of Alzheimer’s Society campaigners have written to their own MPs as well. I would welcome a commitment from the Minister to look at the proposal, and her support in getting the Government to include a dementia fund in the forthcoming spending review, to end the unfairness for people with dementia.

Another key area is transport. Access to public transport can have a huge impact on the lives of people affected by dementia, helping to reduce loneliness and social isolation by linking someone to their community and friends, and providing links to essential services such as necessary respite care. Access to public transport is therefore critical to maintaining someone’s quality of life. However, accessing transport can be very challenging for people with dementia. We heard many stories of how poor or inaccessible transport is, preventing people with dementia from participating in society, despite rights to accessible transport being enshrined in the Equality Act 2010.

Our report stresses the importance of reviewing any changes to bus and community transport services in the context of the public sector equality duty, to ensure that reasonable adjustments are made to enable people with dementia to continue to use public transport. Local authorities have a huge role to play here, and I hope that they will take steps to support people living with dementia in their communities.

On housing, the inquiry found that people with dementia are frequently being denied their right to live independently in their own homes, where they are able to make their own choices. It is important that people with dementia are supported as much as possible to stay as long as possible in their own home or to access suitable supported housing. People with dementia have the right to personal choice over where and how they live. We believe that people living with dementia must have access to adaptable housing, trained home care staff, and specialised supported housing schemes.

The final area is community life. The evidence supplied to our inquiry reaffirmed the importance of supporting people with dementia to continue to lead full and independent lives. That means creating communities where no one is excluded or has to face dementia alone. The all-party parliamentary group praised the work of the Dementia Friends programme, which helps to raise awareness of the condition and has created almost 3 million Dementia Friends in England, Wales and Northern Ireland—5,000 of them in my constituency of Oldham East and Saddleworth, a fact that I am very proud of.

A particularly relevant recommendation of the report is for Westminster to become the world’s first dementia-friendly Parliament, including ensuring that the parliamentary estate is a safe and welcoming place for people affected by dementia to work and visit. I have met a number of people today who are visiting Parliament; I hope they will be able to report positively on how they have been received today.

Our report is wide-ranging and covers a number of different issues that need to be addressed if the disability rights of people living with dementia are to be realised. Over the coming months, the all-party parliamentary group on dementia will work with the Alzheimer’s Society and other partners to turn the report’s recommendations into reality. That has the potential to have a huge impact on the lives of people living with dementia and their carers, and I hope that everyone in the Chamber today and beyond will offer their support.

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[Debbie Abrahams]

I thank everybody for their excellent contributions to a really important debate. I particularly thank those who shared their personal stories. Such empathy makes a difference to people who have dementia and to their carers, and I thank Members for that. There were examples of excellent practice. In different parts of the country, excellent work is going on, and we need to make sure that it goes beyond Members’ own constituencies. The key thing is national leadership. I know the Minister is committed. On the areas around housing, transport and social protection, which are not necessarily in her brief, I would be grateful if she made sure her colleagues are aware of the recommendations.

Motion lapsed (Standing Order No. 10(6)).

Health

Debbie Abrahams Excerpts

Tuesday 14th May 2019 Commons Chamber

[Matt Hancock]

Yes. We can only fund a stronger health service and we can only fund strong public services if we have a strong economy and that would be put at risk by the recklessness of the Labour party. Let us talk about the details of how we are going to improve healthcare in this country, but let us say first and foremost that we can fund public services only if we can ensure that the economy is run well.

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

Would the Secretary of State like to address the issues that my hon. Friend the Member for Leicester South (Jonathan Ashworth) raised? We are seeing a flatlining of life expectancy, with the infant mortality rate having increased for the first time in 100 years. Will he address that in his response, please?

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

For the first time since the 1890s, we are seeing a slowdown in health improvements, including, as we have heard, a flatlining in life expectancy. However, that varies in different parts of the country. Men’s average life expectancy in Windsor and Maidenhead is 81.6 years, while in my constituency it is 77 years. As well as the data from the Office for National Statistics, we have information from the Institute and Faculty of Actuaries that falling longevity has accelerated. Last year’s analysis cut forecast life expectancy by two months, and this year it took off another six months. Since 2015, it has fallen by 13 months for men and 14 months for women. That renders the Government’s increase in the state pension age an absolute nonsense, and is rather cruel to women born in the 1950s.

Healthy life expectancy—how long we expect to live in good health—has also declined for women, by three months between 2009 and 2011. That, too, varies across local authority areas, by 21.5 years for females and 15.8 years for males. Our children have been affected as well. As the Royal College of Paediatrics and Child Health reported last year, infant mortality is on the increase for the first time in 100 years. Four out of 1,000 babies will not see their first year, which is an indictment of the fifth richest country in the world. We are also seeing increases in child mortality, linked closely to the poverty that children are experiencing.

Why is this happening? It is absolutely true that the cuts in public health spending which were described so eloquently by my hon. Friend the Member for Stockton South (Dr Williams) have played a part, but they are not the only cause of the decrease in life expectancy and other problems. We know that investment in the NHS has been far from perfect, and it should have been at least £30 billion by 2022 instead of the £20 billion that has been promised. The coalition Government have a lot to answer for with the Health and Social Care Act 2012, which championed the outsourcing of NHS contracts to the private sector among other things. There is also strong evidence that that has contributed to not only increases in inequality in access to health care but inequality in outcomes.

There is clear evidence, as many of us predicted, of the impact of the coalition Government’s and this Government’s wider austerity programme. It has widened the inequalities of income, wealth and power and contributed particularly to the premature deaths of many of our citizens.

I welcome the launch today of Sir Angus Deaton’s inquiry to review inequalities across our country, and I hope it builds on the evidence Kate Pickett and Richard Wilkinson produced in their totemic publication “The Spirit Level” a decade earlier. However, we also need to explore other aspects of inequalities that have been not yet been investigated, such as the inequalities in power and the rise of nationalism.

I also hope that the inequality review analyses evidence presented at a recent event I chaired. Professor Danny Dorling referred to Office for National Statistics data published the day after the EU referendum showing that there were 52,400 more deaths than the previous year. This was the seventh largest single-year increase in deaths after cholera caused an increase in 1849. The evidence showing a correlation with austerity, as people’s long-term care needs were most affected, is compelling. We now have the 10th lowest level of public spending out of 12 developed countries, and in 2018 some 1.4 million older people had unmet care needs.

Professor David Taylor-Robinson provided evidence showing that the impact of austerity is also taking its toll on our children. His report, “Due North”, provided evidence of the north-south divide and the impact on health, including child health. We now have the worst child health in western Europe and rising child mortality, which is clearly associated with child poverty.

The Government’s first duty is to protect their citizens. For our children, our old people and our disabled people, it is clear this Government have failed and I urge them to take this more seriously.

Oral Answers to Questions

Debbie Abrahams Excerpts

Tuesday 26th March 2019 Commons Chamber

[Matt Hancock]

My right hon. Friend was not only a very good Whip, but is a very good constituency MP. He has made his case very well. “Shaping a healthier future” is no longer supported by the Department of Health and Social Care, NHS Improvement or NHS England. The NHS will look at parts of the proposals that are in line with the long-term plan, such as the aspects that are focused on expanding the treatment of people in the community. As for the changes in A&E in west London that are part of “Shaping a healthier future”—for instance, those at Charing Cross Hospital, which he mentioned—these will not happen.

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

T6.   My constituent, who has terminal secondary breast cancer, has had her personal independence payment assessment refused and is having to appeal the decision, in spite of doctors’ letters detailing her debilitating condition and the treatment regimen she has to go through. What discussions has the Health Secretary had with the Secretary of State for Work and Pensions on how to ensure that medical evidence of that sort is accepted, so that people with terminal and progressive conditions do not have to go through this awful process?

[The Parliamentary Under-Secretary of State for Health and Social Care (Jackie Doyle-Price)]

The hon. Lady makes a very good point. I had regular discussions with the sadly departed Minister for Disabled People, Health and Work, who provided really great challenge within the Department for Work and Pensions about how it handles such assessments. We must do all we can do to humanise them, especially when people are going through periods of ill health.

Health Inequalities

Debbie Abrahams Excerpts

Wednesday 20th March 2019 Westminster Hall

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

It is a pleasure to serve under your chairmanship, Mr Hollobone.

I congratulate the hon. Member for Telford (Lucy Allan) on securing the debate. She was absolutely right to say that, as important as our NHS is in treating and caring for us when we get ill, reducing health inequalities —in my Oldham East and Saddleworth constituency, there is an 11-year life expectancy gap between rich and poor—goes beyond the NHS and the Government’s 10-year plan.

The term “health inequalities” refers to the increasing mortality and morbidity that occur with declining socioeconomic position. This is the systematic, socially reproduced, differential distribution of power in relation to 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. Those things, rather than biological and behavioural differences, drive these inequalities. No law of nature decrees that the children born to poor families should die at three times the rate of children born to rich families, but that is the reality in 21st-century Britain.

Given that those health inequalities are socially produced, they are not fixed or inevitable. If the Government were committed to tackling these burning injustices—let us face it, what could be more unjust than knowing you are going to die earlier because you are poor?—a starting point would be to tackle their regressive, unfair economic and social policies.

Countries that have a narrow gap between rich and poor have not only higher life expectancy rates, but better educational attainment, social mobility, trust between communities and so on. Fairer, more equal societies benefit everyone. Unfortunately, the concentration of power in tiny elites is happening more than ever in the UK.

Just four weeks ago the Office for National Statistics published data with more evidence that these inequalities are on the increase, with income inequalities increasing in 2018. The average income of the poorest fifth of the population after inflation contracted by 1.6% in the last financial year, while the average income of the richest fifth rose by 4.7%. This followed “fat cat Friday” in January when it was revealed that top executives were earning 133 times more than their average worker—up from 47 times more in 1998.

At the same time we are seeing increases in both infant and child mortality, which—as shown in the latest study, just 10 days ago—correlate with increasing child poverty. These increases, the first in 100 years, mean that four babies in 1,000 will not see their first birthday in the UK, compared with 2.8 in 1,000 in the EU.

Two weeks ago life expectancy estimates were revised downwards by six months by the Institute and Faculty of Actuaries in its latest mortality projections model. The institute now expects men aged 65 to die at 86.9 years, down from its previous estimate of 87.4 years, while women who reach 65 are likely to die at 89.2 years, down from 89.7 years. Public Health England’s investigation into flatlining life expectancy revealed—as many of us, including Sir Michael Marmot, have said for a number of years—that austerity has wrought misery and poverty, and ultimately an early death for too many of our citizens.

As analysis from the Institute for Fiscal Studies and others has shown, since 2015 the lowest income decile has lost proportionately more income than any other group as a consequence of personal taxation and social security measures. Last autumn’s Budget had only marginal impacts on the household income of the poorest, while reducing the number of higher rate taxpayers by 300,000. Last week’s spring statement followed that trend. There was nothing for the 8 million working poor, the 4 million children living in relative poverty or the two thirds in working families, and nothing for the 4 million disabled people living in poverty.

These health inequalities are socially produced, so they are not fixed or inevitable. They can be changed, and that should give us hope.

--- Later in debate ---

[The Parliamentary Under-Secretary of State for Health and Social Care (Jackie Doyle-Price)]

It is a pleasure to serve under your chairmanship, Mr Hollobone, and to respond to the debate. I feel that it is a major challenge and an absolute responsibility for Ministers in the Department to do everything we can to tackle inequalities. Frankly, that is why all of us got involved in politics and stood for public office, because we want to do the best for everyone in our society.

I pay tribute to my hon. Friend the Member for Telford (Lucy Allan) for her very persuasive argument in opening the debate. She has been an absolutely fantastic champion for her constituents, at a time when difficult decisions are being made about how to reconfigure health services in her area. She has not been backward in coming forward to make her case, because this is the second time that I have responded to her on it. I know that she will continue to make her case.

I will just say something about some of the concerns that my hon. Friend has raised. When the NHS makes decisions on how best to deliver health services for a local community, clearly those decisions are made locally and should be locally responsive. However, it is equally the case that the public become very nervous about the potential downside of any decision. It is therefore absolutely crucial that engagement is constructive, with dialogue and transparency, so that the public can have confidence that the right decisions are being made.

My hon. Friend articulated her case with clear reference to inequalities in the area that is served by that configuration. It is important that we have a way of addressing those points, because there is a perception that the pointy-elbowed middle classes are better at fighting for themselves than everyone else is. We all have a duty to ensure that everyone can have confidence in the decisions that are made. I encourage my hon. Friend to continue to give challenge, because it is only when we provide her with answers that she can give her constituents reassurance. I know that she will continue to give that challenge.

On that basis, I would give a gentle prod to some organisations within the NHS. We often find that some areas are better at consultation than others, but we are elected representatives who are here to give challenge on behalf of our constituents, and I would like to send a message that the NHS needs to be more transparent in its decision making throughout.

I thank all Members for their contributions to this debate, and I will try to address most of the points that have been raised. Turning to the legal duties on the Secretary of State, we have regard to the need to reduce health inequalities. That requires concerted effort across all our health services. That is a priority for us, and it is a particular priority for me. Clearly, other factors contribute to poor health outcomes and inequalities, which go beyond the gift of the NHS and the Department of Health and Social Care, meaning that we need to take a cross-Government approach to the problem. Housing is clearly an issue; we know that poor-quality housing can be a driver of ill health and health inequality. We have heard about employment and income, and clearly education is a factor as well. We need to equip everyone with the tools to live a healthy lifestyle and look after themselves well. Equally, this issue is about access to services, and we know that there is much we can do within the NHS and the wider healthcare system.

[Debbie Abrahams]

Is the Minister aware that there was an interdepartmental public health group specifically to look at the wider determinants of health and how each Department could do its bit? Would she consider re-establishing that group to address the important issues that have been raised?

[Jackie Doyle-Price]

We have a number of inter-ministerial groups looking at particular areas of inequality, such as rough sleeping and the first 1,001 days. The hon. Member for Central Ayrshire (Dr Whitford) spoke about the importance of early intervention; if we could get that right, that would be a real way of addressing inequality. My short answer to the question asked by the hon. Member for Oldham East and Saddleworth (Debbie Abrahams) is that we pick up public health in a number of ways, but my priorities are the first 1,001 days and particular pinch points where there are real inequalities. We will continue to look at those areas, not least because supporting those individuals is not just better for them, but makes financial sense. If we can tackle some of these issues earlier, not only do individuals live longer and healthier lives, but there is a reduced cost for the health system.

DRAFT GENERAL FOOD HYGIENE (AMENDMENT) (EU EXIT) REGULATIONS 2019 DRAFT CONTAMINANTS IN FOOD (AMENDMENT) (EU EXIT) REGULATIONS 2019 DRAFT SPECIFIC FOOD HYGIENE (AMENDMENT ETC.) (EU EXIT) REGULATIONS 2019 DRAFT GENERAL FOOD LAW (AMENDMENT ETC.) (EU EXIT) REGULATIONS 2019

Debbie Abrahams Excerpts

Tuesday 5th March 2019 General Committees

[Steve Brine]

I shall work in reverse and begin with the comments of the hon. Member for Poplar and Limehouse, who is a good man. He may not have been a public health Minister, but if he had been, he would have been a very good one. We have engaged with certain issues many times in Westminster Hall and I know exactly where he would place his focus if he were in my job. Hey, he might be one day—who knows?

To begin with the point about transposition, the simple answers is yes. As I said, the European Union (Withdrawal) Act 2018 allows us only to do the housekeeping. That is effectively what these constant fun Tuesday mornings about. They are about the housekeeping and transposing regulations into domestic law. I cannot imagine why anyone would oppose them, because it would be to oppose the status quo, which, I think everyone agrees, keeps the public safe.

There were lots of questions from my dear friend and shadow, the hon. Member for Washington and Sunderland West. She started where she always does, and I shall start where I always do, with the withdrawal agreement. Let us remember, we are not discussing a deal, or a future trade deal, but a withdrawal agreement—a divorce, if you like. Yes, there is no withdrawal agreement yet, and there are 24 days, but the hon. Lady knows what I am going to say. She has a golden chance next week, on or before next Wednesday, to change that.

As to scrutiny, we have spent quite a lot of time in Committee sittings scrutinising SIs together, and in some ways it has been an interesting spring cleaning process, has it not? We have delved into some regulations that I suspect have not been discussed in this place for a long time. The hon. Lady rightly says that we cannot get this wrong, because we have to bear in mind consumer confidence always. That is why we are so keen to get things right.

The hon. Lady raised the issue of relaxation, but that would not happen under the present process, because, as I said to the hon. Member for Poplar and Limehouse, this is a process of transposition. Any relaxation—or indeed increase—of rules in the area in question would be subject to discussion, consultation and approval by this place. That is when we finally find out what “take back control” means.

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

This follows on a little from what the Minister has been saying, but I understand that rates of food poisoning in the US are 10 times those of the UK, and the death rates from food poisoning are also much higher. Whatever happens next week, will the Minister assure us that any trade deals negotiated with the US and elsewhere will involve the same standards of food safety that we require now?

[Steve Brine]

What I can do is repeat the words of the Prime Minister and the Secretary of State for Environment, Food and Rural Affairs, who have said that there will be no diminution of food safety standards in pursuit of trade deals with the US or anywhere else; and even if such changes were proposed, Parliament would have the final say. Hon. Members can read the paper that was set out last week, on how the Government would conduct future trade negotiations and engage with Parliament. I think we know where Parliament would stand on the matter of diminution of food standards.

[Debbie Abrahams]

rose—

[Steve Brine]

I am happy to give way to the hon. Lady a second time, but then I must make progress.

[Debbie Abrahams]

The Minister is always very kind. Can I assume, then, that he and his Secretary of State have sent a letter to the US ambassador, giving short shrift about our agricultural farming methods?

[Steve Brine]

I do not think that we have sent a letter. I am not sure that it would be my place to do so anyway, but the British Government have been crystal clear that we do not expect any degradation of food standards in pursuit of a future trade deal. That has been said by the Prime Minister, down to those at my lowly rank.

To go back to what the hon. Member for Washington and Sunderland West said about maintaining high standards of food safety, leaving the EU does not change our top priority, which is to ensure that UK food remains safe, and that the label says what it is. The Food Standards Agency is working very hard to ensure that high standards of food safety are maintained. We are committed to having a robust regulatory regime in place from day one that will mean that businesses can continue as normal. That is why we are transposing the legislation word for word.

The hon. Lady talked about RASFF, the rapid alert system for food and feed, to which the UK is a major contributor. RASFF facilitates vital food and feed safety data sharing. It is clearly of mutual benefit to the UK and our EU partners to share food and feed safety information quickly, so securing continued access to, and participation in, the system after leaving the EU is one of our top food safety priorities. We continue to press for full access to that vital data-sharing system in our negotiations with the EU. Even as a third country, the UK will continue to receive information from the EU as required by EU law—it is worth putting that on the record—where a food or feed subject to notification under the rapid alert system has been dispatched from the EU to the UK. However, not having full RASFF access would mean less data than is currently available, which may affect UK timely communications on food safety issues.

With regard to actions that we will take to mitigate the loss of full access, the FSA has been building on proven mechanisms, such as the monitoring of key data sources and a new strategic surveillance programme, to enhance its capability and capacity to respond effectively to any food-borne contamination or outbreak incident that occurs in the UK, for the protection of our consumers. In terms of other international engagement, the FSA is implementing an enhanced programme of bilateral engagement and surveillance that focuses on the exchange of information on risks to the food chain. It is engaging with competent food safety authorities across Europe and worldwide, building on its strong reputation and established contacts to develop a mutually supportive approach to information sharing on food safety incidents.

There is no getting away from the fact that we have decided to leave, and are leaving, the EU. We therefore will leave some of its processes, one of which is the RASFF. However, as I have said, we will do our utmost to secure continued access to it—we were, of course, a huge contributor to establishing it in the first place. If we cannot, some of the mitigations that I have outlined will be important.

The hon. Member for Washington and Sunderland West asked about the FSA. Her Majesty’s Treasury has made significant extra funding available to the FSA to increase staff, for instance, some of whom are in the room. The FSA’s resource has expanded to ensure that it can undertake the assessment and the risk exercise, to ensure food safety. In answer to a direct question, I am satisfied that it has the new resources that it needs.

The hon. Lady asked about the additional burden on industry for enforcement. We do not expect any additional enforcement burdens. The law and the regulations remain exactly the same, which is why I addressed the transposition point first in my response. She also mentioned the need for clarity on the transition period for businesses to implement any changes. As I have said, the transition period will involve the continuation of the existing standards, so businesses will not need to adapt to any extensive changes.

I was asked whether we will fund local authorities for additional burdens. We are providing support to enforcement officers in local authorities to allow them to continue to enforce the legislation. However, no policy changes are being made in practice. For labelling changes domestically, the transition period will be considered. We may talk about such statutory instruments in future happy moments, but today’s legislation is not about the labelling of products. Of course, we will have a whole new freedom once we leave the European Union in terms of labelling. I have talked about that in other policy areas—around obesity, for instance, with traffic light labelling.

The hon. Lady talked about 60 minutes of familiarisation not being realistic. Were there substantial changes, I suppose that that would not be realistic, no matter how fast one reads. However, businesses will need little familiarisation time, for the reasons that I have said.

Finally, the spokesperson for the Scottish National party, the hon. Member for Motherwell and Wishaw, talked about the importance of Scottish food exports. They are indeed very important to the country, including within the UK single market. That is why there is some level of consistency, and why we expect to have convergence across the four nations of the UK. That is very important for the internal market, and for Scottish food exports to the EU. I know what I would do if I represented a seat in Scotland and the Scottish food industry: I would ensure that we have a smooth and safe transition out of the EU at the end of March. There will be a golden opportunity for the hon. Lady to do that next week.

Resolved,

That the Committee has considered the draft General Food Hygiene (Amendment) (EU Exit) Regulations 2019.

Draft Contaminants in Food (amendment) (EU Exit) regulations 2019

Resolved,

That the Committee has considered the draft Contaminants in Food (Amendment) (EU Exit) Regulations 2019.—(Steve Brine.)

Draft specific Food Hygiene (amendment Etc.) (EU Exit) regulations 2019

Resolved,

That the Committee has considered the draft Specific Food Hygiene (Amendment etc.) (EU Exit) Regulations 2019.—(Steve Brine.)

Draft General Food Law (amendment Etc.) (EU Exit) regulations 2019

Resolved,

That the Committee has considered the draft General Food Law (Amendment etc.) (EU Exit) Regulations 2019.—(Steve Brine.)

Mental Capacity (Amendment) Bill [Lords]

Debbie Abrahams Excerpts

3rd reading: House of Commons & Report stage: House of Commons
Tuesday 12th February 2019 Commons Chamber

[Mr Dhesi]

I thank the hon. Lady for her intervention, but in terms of human rights, this issue is being raised not just by me, but by more than 100 pre-eminent organisations in the field. The only way to solve that is through funding—that is the only way in which we can lay this matter to rest. The hon. Lady highlighted the 2017 Law Commission review of the deprivation of liberty safeguards, which stated that the current regime is

“in crisis and needs to be overhauled.”

I agree. There is a crisis and the current system cannot cope, but surely the answer is not to replace bad laws with yet more bad laws, and that is what we are in danger of doing.

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

I will be brief. My hon. Friend the Member for Rhondda (Chris Bryant) has tabled an excellent amendment, which I support. We know that the system is broken. What we are doing is replacing it with an even worse system. Just to acknowledge how broken the system is, the Alzheimer’s Society’s national dementia helpline receives over 100 calls a month about the Mental Capacity Act, which is clearly confusing and complicated for people with dementia, as well as for their families and carers. However, as we have heard, so many different disability organisations and a whole range of charities, as well as the Law Commission, are saying that this Bill is not fit for purpose.

I particularly support the amendments tabled by my hon. Friend the Member for Rhondda. The Greater Manchester Neuro Alliance, which I have supported for several years now, has several concerns, particularly about a person who presents inconsistently and has a cognitive impairment, mental health problems or is simply vulnerable and does not accept or appreciate their illnesses and the limitations. One member of the alliance from Oldham told me:

“My son has been deemed as having capacity because he can answer questions yes or no but he can’t be left alone or allowed to go out unsupported, he doesn’t take his medication and doesn’t have the ability to plan or manage anything including lifesaving treatment every three weeks”.

Such examples are not addressed in the Bill.

I will move swiftly on, Madam Deputy Speaker. I share the concern that my hon. Friend the Member for Worsley and Eccles South (Barbara Keeley) has expressed so clearly about care home managers and the conflict of interest in the Bill. It is a minefield and needs to be addressed. She made that point clearly.

Amendment 48, tabled by my hon. Friend the Member for Stockton North (Alex Cunningham), would rightly prevent cared-for people from being charged for the assessments required by the system, potentially providing a financial incentive to do the mental capacity assessments. Without the amendment, we cannot be sure that people will not be charged more for their care solely because they require liberty protection safeguards to be granted. If the Minister does not accept the amendment, I would like to know why. On advocacy, we need to ensure that the “best interests” test is changed to place more weight on a person’s wishes.

There are several other issues with the Bill. It has not had a sufficient airing. It has not been consulted on greatly, but I will hand over to my hon. Friend the Member for Stockton North.

[Alex Cunningham (Stockton North) (Lab)]

I had hoped to address several of the amendments signed by my hon. Friends and me, because this is a bad Bill with huge opposition across our society. It fails to protect people adequately, meaning they could be locked up without a proper process of assessment and without advocacy support—and that includes 16 and 17-year-old children. The protections for them are also inadequate, as they are for their parents. Time is against me, however, so I will turn straight to amendment 48, which stands in my name and that of my hon. Friend the Member for Oldham East and Saddleworth (Debbie Abrahams).

There is a genuine concern among organisations in the sector that vulnerable people, particularly those receiving private care, may be charged for an assessment or for assessments to be carried out. I know the Minister got a bit fed up with me banging on about funding and about the fact that local authorities such as mine in Stockton-on-Tees have lost millions of pounds in funding and that budget reductions are continuing across health. I have also addressed the tight margins on which care homes operate and the need to ensure the sector remains viable.

We know that the sector is strained financially and might feel it has no choice but to implement fees and charges for the assessment of clients’ mental capacity. The intention of the amendment is to ensure that this does not happen. Several written submissions to the Public Bill Committee raised concerns about the absence of any provision for a fee for medical professionals to provide medical evidence.

This is the right point to refer to the revised impact assessment published by the Government. I and other Opposition Members have been contacted by academics accusing the assessment of perpetuating a myth by saying that GPs will provide diagnostic evidence and conduct capacity assessments for the LPS and that this will have no resource implications. What total nonsense. How has this conclusion been reached? I have not heard from a single body or GP arguing it will have no resource implications—quite the opposite.

The experience of judicial DoLS applications to the Court of Protection seems to be that GPs are very reluctant to provide such evidence, either because they do not feel skilled enough to do so or because they require payment. This means that someone will have to pay a fee for the medical assessment, and there is nothing in the Bill or the NHS charging regulations to prevent it from being passed on to the person themselves.

Evidence shows that that is already happening. Southfield House, a care home in Stockport, was found to be charging residents £250 if they required a deprivation of liberty authorisation. A complaint was lodged with the Care Quality Commission by Edge Training, but it was told in response that that was allowed. What was that £250 for? “An application to the local authority requesting an assessment” appears to cover it—and after that, there was the £125 annual fee. Individuals who are going through what can only be an extremely emotionally difficult process are being charged hundreds of pounds for the luxury.

It is frustrating that the care home is well within its rights to make those charges. A spokesman put it best:

“The social care sector…is currently under huge financial pressure. All tasks from care to admin to facility carry a cost”.

Because the sector is underfunded, the Government consider it appropriate to take financial advantage of the most vulnerable people in society.

I do not intend to press the amendment to a vote, but I think that the Minister must take on board the whole issue of charges. At present, the law gives care home managers and others carte blanche to charge exactly what they want. There are no limitations whatsoever. I ask the Minister, perhaps at the regulations stage, to come back with specific ideas to restrict care home managers and others from exploiting those vulnerable people.

NHS Long-term Plan

Debbie Abrahams Excerpts

Monday 7th January 2019 Commons Chamber

[Matt Hancock]

My hon. Friend is absolutely right. When people are in hospital, there will now be much more aggressive provision of counselling and support to stop them smoking. It is also about targeting support, rather than treating everyone the same and giving them the same messages. It is absolutely right to include micro-targeting and to use social media to communicate with people. There are luddites who say that we should not use these modern approaches, but we on the Government Benches believe in the future.

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

I am pleased that the Secretary of State is keen to improve public health and reduce health inequalities, and I assume that he will therefore support my new clause 5 to the Finance (No. 3) Bill, which is specifically about ensuring that the Government’s economic policies reduce health inequalities. On social care, is he aware that in 2017 alone 50,000 people with dementia had an emergency hospital admission because there was not adequate social care? What will he do to ensure that his plan, which we are still waiting for, will avoid such emergency admissions in 2019? Please do not say that more has been given in the Budget, because that is a sticking plaster compared with all the cuts that the Government have made in social care.

[Matt Hancock]

Page 32 of the document sets out details on the integration with social care that the hon. Lady rightly calls for. Clearly, ensuring better integration in cases of dementia is absolutely vital. Some parts of the country are doing that brilliantly with integrated commissioning, but we need to ensure that is spread across the whole country.

Oral Answers to Questions

Debbie Abrahams Excerpts

Tuesday 27th November 2018 Commons Chamber

[Caroline Dinenage]

I congratulate my hon. Friend on all the excellent work that he is doing to draw attention to this condition, and I should be happy to meet him.

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

6. What assessment he has made of recent trends in the level of health inequalities across England.

[The Parliamentary Under-Secretary of State for Health and Social Care (Jackie Doyle-Price)]

We know from recent trends reported to the public health outcomes framework that health inequalities persist in this country. We already have world-leading programmes to address the root causes of poor health, including programmes to deal with childhood obesity, control tobacco and prevent diabetes and heart disease. The Prime Minister has set an ambition to ensure that people can enjoy at least five extra healthy independent years of life by 2035, while narrowing the gap between the experiences of the richest and the poorest, and next year the Secretary of State will set out further plans to achieve that in his prevention Green Paper.

[Debbie Abrahams]

We have known for decades that poverty and economic inequality drive health inequalities. The richer people are, the longer they live, and the longer they live in good health. In addition to the economic analyses of the Prime Minister’s Brexit deal, what assessment has the Minister made of the deal’s impacts on health inequalities, and on life expectancy and healthy life expectancy, which we know are already falling in some parts of the country, and among some groups of people?

[Jackie Doyle-Price]

The reasons for health inequalities are complex, but obviously we encourage people to make the lifestyle changes that enable everyone to live longer. I simply do not accept that the direct causality that the hon. Lady has outlined is as clear as that. We will focus on programmes that help people to lead healthier lives with better diets; that tackle tobacco control; and that prevent diabetes.