Public Health: County Durham

Helen Goodman Excerpts

Wednesday 12th June 2019 Westminster Hall

[Mr Kevan Jones (North Durham) (Lab)]

I beg to move,

That this House has considered public health in County Durham.

It is a pleasure to serve under your chairmanship, Mr Owen. I am pleased to have secured this debate, but it is unfortunate that we have to have a debate on public health to highlight the effects that the Government’s cuts have on one of the poorest counties in our nation. I thank the men and women of the NHS, those who work in public health for the county council, and the voluntary and community sectors, which are part of the matrix of support for delivering in County Durham not only general healthcare, but, importantly public health.

In recent years, there has been debate about Government funding not just in health, but in local government and other areas. That debate starts from the premise that everywhere is the same, so a fair funding formula spreads the jam evenly around the country, but I am sorry—that is just not the case. Deprivation and need are factors that must be taken into consideration. In local government funding, fire service funding and police funding, need and poverty have been removed as determinants.

County Durham is a large rural county of 525,000 people. It faces some unique issues on health, partly because of the legacy of the county’s industrial past of coalmining and heavy industry, which means a high incidence of diseases associated with those industries, such as respiratory diseases, which put particular demands on the health service.

We also have a legacy of rapid deindustrialisation in the 1980s, when the hearts of many of the coalmining and steel communities across County Durham were ripped out by the policies of the Thatcher Government. That legacy remains in terms of hopelessness, drug and alcohol abuse, obesity and smoking, as well as the poverty that goes with all that. Previously, I have described County Durham as a rural county with urban problems, but those urban problems are sometimes ignored because of County Durham’s rurality.

We also have a growing elderly population. In the period to 2035, the number of people aged 65-plus will rise by 31%, and the number of people aged 85-plus will rise by 82%. That puts particular demand on the health service at all levels, in both the community and the acute sectors. Life expectancy in Durham is 78.3 years for men and 81.4 years for women. I will mention two other counties, and allude to the reasons for doing that later in my remarks: in Surrey, life expectancy is 81.5 years for men and 84.8 years for women, while in Hertfordshire, it is 81 years for men and 84.2 years for women.

The figures for healthy life expectancy, which indicates the age at which people develop serious health concerns, are even worse. In County Durham, they are 58.9 years for men and 58.7 years for women, whereas in Surrey, they are 68.3 years for men and 68.7 years for women, and in Hertfordshire, 64.9 years for men and 65.9 years for women. People in County Durham who get long-term health issues get them sooner than people in more affluent areas, which leads to demand on our health service. We are always told by the Government that we need to stop people using the health service to reduce the demand placed on it, but unless we tackle some of the underlying causes of the problem that pressure will continue.

Responsibility for public health funding was transferred from the Department of Health and Social Care to local government in 2013-14. I supported that move because public health is best delivered locally. The budget devolved to County Durham in 2013-14 was £40.5 million, based on the assessment of health needs by the primary care trust, which was abolished under the same legislation that introduced the transfer of responsibilities. To give credit to County Durham, it has used that money effectively, with services commissioned both directly by the county council and externally by private and third-sector organisations.

As with many things, however, devolution of responsibility for public health came with a sting in 2016, when the budget was reduced by 12.8%. That was part of George Osborne’s strategy, in a host of areas, to devolve money locally and tell the local authority to decide where the cuts would come. He could then stand back and say, “That decision has to be made locally.” But that misses the point. By sleight of hand, he sought to give the idea that somehow he had no responsibility for the cuts when he had top-sliced the budgets.

To be fair to County Durham, its public health priorities were the right ones to tackle. The funding was directed towards the control of tobacco and cessation of smoking, teenage pregnancies, obesity and weight reduction, mental health—an issue close to my heart—and improved dental services. I do not know whether the Minister is aware of this, but when I was first elected in 2001, certain areas of my constituency had no access to dental services at all. That has changed—not since 2010, I hasten to add, but certainly under the last Labour Government.

County Durham also targeted drug and alcohol addiction. I give it credit for the work that it has done on that. In the light of the recent confessions of the Conservative party leadership contenders, I think that they could take note of the available drug and alcohol services. However, unlike those middle-class people who have confessed to drug use, the young people we are talking about will not go on to glittering careers in the media or elsewhere. They will be pushed into a cycle of poverty and desperation at local level, and will add to our shared tax burden, because their demand on health, police and other services will increase. I always look at public health as an investment in our local communities to ensure not only that we have good public health outcomes, but that we reduce demand elsewhere in the system.

[Helen Goodman (Bishop Auckland) (Lab)]

Before my right hon. Friend moves on to the next section of his speech, I want to congratulate him on securing this important debate. What shocks me is the fact that in Woodhouse Close in my constituency, the healthy life expectancy is 10 years lower than that in Barnard Castle, yet those two places are only 10 miles apart. The notion of cutting public health funding seems grotesque.

[Mr Jones]

My hon. Friend is correct. She highlights that example in County Durham, but there are many more between the more affluent areas and the pockets of poverty. They have been there since the 1980s and they need to be addressed. I am passionate about this issue; the idea that where someone lives should determine how long they live, in a wealthy country such as ours, is wrong. We should be able to tackle that in this day and age.

The new funding formula, ironically called the fair funding formula—trades description comes to mind—is based on the premise, pushed mainly by a lot of Conservative Members, that somehow the needs of individuals in health and other areas are the same across the nation. That is just not the case. The methodology put forward by the Ministry of Housing, Communities and Local Government means that County Durham will lose 38% of its existing budget—that is £18 million a year. It is the worst loser in this process, because the dedicated, ring-fenced public health budget is being abolished. It is being pushed in terms of the business rate retention scheme, which concerns me because it means that there will be areas where councils—I will refer to two in a minute—that get a budget increase will have no duty at all to ring fence that money and put it into public health. That is a retrograde step.

County Durham has achieved a lot: smoking is 22% down and teenage pregnancy is down to a level that is no longer statistically different from national averages. That certainly was not the case when I was first elected in 2001. We have made great strides getting cardiac mortality down from 31 deaths per 100,000 in 2001 to 5.7 deaths per 100,000 by 2015. A lot of effort has gone into addressing suicide rates, particularly among men. That is a credit to multi-agency work, including the police, the voluntary community sector and others. We have a good-news story in the sense that we have a good partnership-working approach in County Durham, yet the Government want to take that budget away.

People ask, “Why can’t it be made up from elsewhere in the council budget?” This is a county council that has had its budget slashed by nearly £240 million since 2010. It is due to lose another chunk of funding under the so-called local government funding formula. The scandalous situation, and the reason I mentioned Surrey earlier, is that, while County Durham will have its budget cut by 38%, Surrey County Council’s budget will be increased by £14.4 million a year, and Hertfordshire’s by £12.6 million a year. It cannot be right—I will give some reasons in a minute—that money is being moved from deprived areas such as County Durham in the north-east to some of the most affluent areas in the United Kingdom. The life expectancy and other figures that I mentioned earlier are not comparable. That is not a fair way of distributing that money.

It is not just County Durham that is affected; the north-east loses some £40 million under the proposals, in some of the most deprived parts of this country. Gateshead, for example, loses 12.44% of its budget; Redcar and Cleveland loses more than 27%; South Tyneside, one of the most deprived parts of the region, loses 29%; and Sunderland loses 24%. That will not address health inequalities and stop people going into the health service; the cuts to the most deprived areas cannot be right.

There is a deliberate policy—not just here, but in other areas—of moving the central Government grants or funding formulas to benefit mainly Conservative-voting southern areas. That is the worst example of pork barrel politics. The Conservative party leadership contenders talk about one-nation conservatism. If this is one-nation conservatism, they can keep it. The cuts will have a direct effect on the ability of healthcare professionals to provide services. It is not acceptable to go backwards on smoking cessation and drug treatment.

What has been going on? The county council has lobbied; it has written to the Minister, met Public Health England and worked with other local authorities not just in the north-east but elsewhere, such as Blackpool Council, which is also affected. It has contributed to the fair funding review. It is not just politicians on the Labour county council; the health and wellbeing boards, the police and crime commissioner, and the local NHS trusts have all argued that this is not correct, because they see what is coming down the road. If these short-sighted cuts take place, the demand on local acute services will go up—exactly what the Government and NHS England want to avoid. That disjointed approach beggars belief.

What do we want in County Durham? We want and need a clear commitment to public health. That is referred to in the NHS forward plan, but with no funding commitment or power to ensure that local councils deliver good-quality public health. We need a form of funding that reflects need. We also need a clarification on timetable. I understand that a decision is being kicked right back to the spending review. When the spending review will take place, given the chaos in the Conservative party, I do not know.

There is real pressure on the county council and other bodies because they have to let contracts—the current contracts come to an end in March next year. If there is no clarification by the end of this year, that will not leave much time for those organisations not only to tender but to let those contracts. That will lead to a lot of organisations worrying about their future. A lot of public health is delivered by the local voluntary community sectors. They rely on that, and they do a fantastic job. We cannot have money deliberately moved to areas of prosperity. I challenge the Minister to conduct an impact assessment on the effects of the cuts, to highlight those effects.

It does not surprise me what the Government are doing because they have done it in every other area, particularly local government funding. I do not question the commitment of the Minister to good-quality public health, but there is a disconnect in relation to the funding formula and the Ministry of Housing, Communities and Local Government. On 7 January, I asked the Health Secretary directly about the issues concerning County Durham. He said:

“That is obviously not right. Indeed, there is a whole section of the plan on reducing health inequalities, which is extremely important.”—[Official Report, 7 January 2019; Vol. 652, c. 77.]

He might recognise the importance of public health, but MHCLG does not. That is not a very good example of joined-up government.

This is not charity; it is an investment, not just in the lives and wellbeing of individual constituents in County Durham but in the future of the country. Unless we tackle some of these health inequalities through good public health, our efforts to relieve the pressures on our health service will come to nothing. In a statement on exiting the EU, the Prime Minister, who will not be with us much longer as Prime Minister, said she wanted to work

“across all areas to make this a country that truly works for everyone, and a country where nowhere and nobody is left behind.”—[Official Report, 10 December 2018; Vol. 651, c. 25.]

If these cuts go through, those words will be pretty hollow, because County Durham will be left behind.