Oral Answers to Questions

Ian Swales Excerpts

Tuesday 10th June 2014 Commons Chamber

[Mr Hunt]

I just point out to the hon. Lady that in the Queen’s Speech we made it clear that we are cracking down on inappropriate payments to people who leave the NHS, many of which are the result of contracts set up by her Government.

[Ian Swales (Redcar) (LD)]

T9. My constituent, Beth Charlton, recently lost her father to pancreatic cancer and notes that patients have only a 3% chance of surviving five years. That is much lower than the survival rates for other cancers and has not improved in 40 years. Will the Minister invest more in early detection and diagnosis of this silent killer?

[Dr Poulter]

Spending on health care research, including cancer research, has considerably increased under this Government, and much of that funding is allocated independently. It is important to note that pancreatic cancer is, as the hon. Gentleman says, a silent killer, because presentation is often very late in the disease process. Patients can present suddenly with painless jaundice and are often only three months away from death. It is therefore important that we look at the causes of pancreatic cancer and focus on primary prevention and on helping people to develop a healthy attitude to alcohol.

NHS Funding (North-East and Teesside)

Ian Swales Excerpts

Tuesday 5th November 2013 Westminster Hall

[Tom Blenkinsop (Middlesbrough South and East Cleveland) (Lab)]

This is an important opportunity to discuss concerns that my north-east colleagues and I have. I hope that the Minister takes our points on board, and takes the necessary steps to rectify the issues in the region’s health service.

I will discuss four topics this afternoon. The first is the funding provided by central Government to the region’s accident and emergency departments, particularly in the south Tees area. The second is the funding of the North East Ambulance Service NHS Foundation Trust, and the rising use and cost of private ambulances. The third is the ongoing Monitor investigations into the two foundation trusts—the South Tees Hospitals NHS Foundation Trust and the Tees, Esk and Wear Valleys NHS Foundation Trust—that serve my constituents. Finally, I will seek reassurance from the Minister on future funding allocations to north-east clinical commissioning groups.

Over the past 18 months, the accident and emergency department at James Cook university hospital, which serves my constituency, has come under particular pressure. In the run-up to winter last year, there were problems with handover times; ambulances and paramedics waited up to two and a half hours to admit patients, despite the national target time being 15 minutes. I raised that last year with the Secretary of State for Health, who agreed that the situation was completely unacceptable, and I raised it with the Minister on 13 February 2013 in a Westminster Hall debate on A and E provision in the north-east. In addition to the issues that I raised with the Secretary of State, it has become evident that the James Cook hospital’s A and E department struggled to manage with the pressure caused by winter.

In January and February 2013, the South Tees Hospitals NHS Foundation Trust failed to meet its target of seeing 95% of A and E patients within four hours. With James Cook hospital so clearly overstretched, I admit that I was surprised to discover in September 2013 that the Secretary of State decided not to award it, or any hospital trust in the north-east, funding to alleviate the pressure on A and E departments. It is beyond belief that, of the £250 million awarded by the Secretary of State between 53 trusts, not a penny will reach the north-east, particularly as we live in a region that suffers from some of England’s harshest winter weather and has some of the harshest local government cuts in the country. I hope that the Minister reconsiders that allocation, or at the very least clarifies why the Secretary of State made such a seemingly absurd and regionally disparate decision.

Recurrently, over many weeks, I have received expressions of concern from constituents about the increasing use of private ambulances in response to 999 calls in my constituency. I corresponded with the North East Ambulance Service on two such incidents, and its reply made it clear that central Government funding cuts are eroding that blue-light service:

“Each year we have discussions with our commissioners on the forecast number of incidents in the forthcoming year. The outcome of these discussions for 2013-14 were that commissioners felt it necessary to set our income on activity for the next 12 months at a level less than we were forecasting… So for 2013-14, we have been contracted to respond to 376,000 incidents, although we are forecasting activity at an estimated 415,000. This means that any incidents above 376,000 will be funded on a one-off basis rather than as recurrent annual income. These arrangements do not allow us to enhance our own workforce plan because the money for the additional activity will not be available next year to fund the extra salaries, overheads and vehicles we need to meet the extra demand.”

[Ian Swales (Redcar) (LD)]

The hon. Gentleman is making a powerful speech. Is he aware that Cleveland police vehicles and staff are also being increasingly used as unofficial ambulances?

[Tom Blenkinsop]

Yes, the police, and particularly the police and crime commissioner for Cleveland, have raised that with me in private meetings on first responder calls. They have funding worries about what will happen if such practices continually recur.

The NEAS letter shows that there will be more cuts, more private ambulances and possibly a less responsive service. It is not me saying that, but the chief operating officer of the North East Ambulance Service. The figures are stark. In 2008-09, 865 call-outs were attended by private ambulances in our region, costing £86,000. In 2009-10, some 1,816 call-outs were attended by private ambulances, costing £151,000. In 2010-11, however, 6,429 call-outs were attended by private ambulances, costing £477,000, which is a huge jump. In 2011-12, there were 9,000 call-outs attended by private ambulances, costing £639,000. In 2012-13, 13,524 call-outs were attended by private ambulances, costing £754,000. So since 2010, there has been a fivefold increase in private ambulance costs in the north-east, with the funds going to private contract firms. It is obvious that from 2010 onwards, there has been an explosion of private ambulance usage by the trust, costing a huge amount of taxpayers’ funds. The chief executive states:

“These arrangements do not allow us to enhance our own workforce plan because the money for the additional activity will not be available next year to fund the extra salaries, overheads and vehicles we need to meet the extra demand.”

A third issue of particular concern to my constituents is that both the NHS trusts that serve them—the South Tees Hospitals NHS Foundation Trust, and the Tees, Esk and Wear Valleys NHS Foundation Trust—have found themselves under investigation by Monitor in the past 12 months. Since May 2010, the South Tees trust has failed on seven occasions to meet its referral-to-treatment target, most recently between March and August. That has resulted in the Monitor investigation, because the trust has failed to ensure that 90% of patients commence treatment within 18 weeks of referral. Furthermore, there has been an increase in reported “never” events at the trust, and an increase in the incidence of clostridium difficile.

Despite the seriousness of those issues, Health Ministers have taken no action. My constituents would at the very least expect Ministers to have had conversations with Monitor and the trust on the issue, and on what support the Department of Health can provide, yet the Under-Secretary of State for Health, the hon. Member for Battersea (Jane Ellison), confirmed to me in a written answer that

“No such discussions have taken place with Ministers.”—[Official Report, 22 October 2013; Vol. 569, c. 83W.]

Will the Minister please assure me that he will closely monitor the situation and have discussions with both Monitor and the South Tees trust on how the Department can provide support, including additional funding if necessary?

My final point is on allocations to the north-east’s clinical commissioning groups.

A recent working paper issued by NHS England on allocation and indicative target allocation outlines proposals that will reduce per-capita funding for CCGs across the north-east. People in Sunderland will each face a £146 cut, people in south Tyneside a £124 cut, people in Gateshead a £104 cut, and people in my constituency a £60 cut.

Tobacco Products Directive

Ian Swales Excerpts

Monday 28th October 2013 Commons Chamber

[The Parliamentary Under-Secretary of State for Health (Jane Ellison)]

It is a pleasure to see you in the Chair, Madam Deputy Speaker. I congratulate the hon. Member for Solihull (Lorely Burt) on securing a very timely debate. I enjoyed her thoughtful speech. I suspect that there will be things on which I cannot respond in quite the level of detail she would want, but she has posed all the important and current questions, and I will try to cover as many of them as I can.

We all agree that smoking has an enormously harmful impact on health. Nearly 80,000 people die in England every year from smoking-related illnesses, and the Government are obviously committed to reducing the number of those premature deaths—it is a priority for us—so this is a welcome opportunity to debate tobacco control. I will first take a moment, however, to highlight the UK’s international reputation on tobacco control. Successive Governments have demonstrated a commitment to improving public health through effective tobacco-control policies, and a wide range of measures have contributed to our long-term success. Over the past decade, complementary domestic and EU legislation has contributed to a decline in smoking prevalence among both adults and young people, and in England today the rate of adult smoking prevalence is under 20% for the first time. But clearly we want to keep making progress.

Since the 2001 tobacco products directive, there have been several scientific and international policy developments on tobacco control, an obvious one being the World Health Organisation’s framework convention on tobacco control, to which every EU member state and the European Commission are parties. It has become necessary to update the current directive, however, and that work is ongoing. The revised directive, to which the hon. Lady devoted much of her speech, proposes new requirements across a range of areas, including: the ingredients and emissions of tobacco products; labelling and packaging; product traceability and security features; cross-border distance sales; and novel and nicotine-containing products. The UK Government welcome the revised tobacco products directive and believe that the proposals will be good for public health across Europe, particularly in helping to prevent children from taking up smoking—it is of concern to us all that the vast majority of smokers started before they turned 18.

Our key objectives for the directive include: bigger pictorial health warnings; ending tobacco with characterising flavours, which the hon. Lady described, including menthol and fruit flavours; and requiring nicotine-containing products such as e-cigarettes to be regulated as medicines. During the negotiations, my predecessor and officials worked to secure adequate freedom for member states to introduce domestic policies within the scope of the directive that aim for a higher level of health protection where justified. That is important because we want to retain the freedom to do more if we want to. For example, we need the ability to introduce standardised packaging if we wish to do so.

[Ian Swales (Redcar) (LD)]

Does the Minister share my concern that some packaging is clearly aimed at children—for example, there is one with a Lego-style pattern called “14”—and women, through pastel colours and so on?

[Jane Ellison]

Yes, I share that concern. I saw a presentation only last week with some of those adverts and imagery. As I said, it is a key priority of ours to prevent children and young people from taking up smoking, so anything that might contribute to their taking it up is extremely worrying.

The UK’s support for the general approach agreed at the June Health Council was important in securing the qualified majority needed to avoid losing hard-won negotiated improvements to the text of the directive. Hon. Members will also be aware that the European Parliament has been scrutinising the proposal, and this is obviously where we have had some recent pushback in some areas. We were pleased to see that, on 8 October, the Parliament agreed with the Council and voted to ban packs of cigarettes with fewer than 20 sticks, to increase health warnings to 65% of the front and back of packs, to make pictorial warnings mandatory throughout the EU—as they are already in the UK—and to prohibit characterising flavours.

It should be noted that the Council and the European Parliament rejected the Commission’s proposal to ban slim cigarettes, so that will not form part of the final revised directive. As the new Minister, I made inquiries into why that was the case, and I understand that there was not enough support among EU member states or parliamentarians for such a ban. We in the UK felt that we had to go with the majority to ensure the progress of the directive, as it will be good for public health overall. That was a pragmatic decision. Like the hon. Lady, I believe that this package of measures will help to reduce the number of young people who take up smoking in the UK.

We are currently considering the detailed amendments that the European Parliament would like to make. We were disappointed that the Parliament did not support the regulation of nicotine-containing products as medicines. We believe that the medicines regulatory regime, applied with a light touch, is the best fit for these products. Although I cannot say too much more about that now, we recognise that there is a lively ongoing debate on that subject, and it is one that we are engaged in. It is also vital that we maintain momentum on the overall negotiations over the coming months, so as to finalise the directive as soon as possible.

The hon. Lady devoted some time to considering what the tobacco products directive will mean for small retailers. As a Back Bencher, I was co-chairman of the all-party parliamentary retail group, and I heard many of the same representations that she mentioned. I recognise those concerns. We recognise that some of the proposals will have impacts on tobacco retailers in regard to the range and pack size of tobacco products that they will be able to sell. During the negotiations, as with all of our tobacco control measures, we continue to consider the impacts on all areas of society, including businesses large and small.

I share the hon. Lady’s doubt that introducing the proposed revised directive, if and when agreed, will have any immediate or drastic effect on small retailers. As she said, retailers face an ongoing challenge to diversify the range of products that they sell so that they are not over-dependent on tobacco sales. British retailers are, and always have been, the most innovative in responding to consumer needs and diversifying. The earliest any new requirements would be likely to take effect in the UK would be 2016, meaning that shopkeepers have time to start making changes now.

The hon. Lady made some interesting points on illicit tobacco. Like her, I have heard that some tobacco manufacturers and retailers believe that certain measures in the proposed directive could drive more smokers to purchase illicitly traded tobacco products. We are not aware of any peer-reviewed and published studies that show that that would happen. However, we are not complacent when it comes to counterfeit or non-duty-paid tobacco products in the UK. The illicit tobacco market is complex and decisions by individuals to get involved in purchasing illicit tobacco depend on a range of factors. The proposed directive envisages a Europe-wide tracking and tracing system for tobacco products, the details of which we are still negotiating in Brussels. The European Commission says that that will reduce the amount of illicit products in the EU. Security features against counterfeiting will also allow consumers to verify the legal status of the products. The hon. Lady suggested that we were perhaps paying insufficient attention to the security features on the packaging, because they are often not very plain at all.

I am glad that the hon. Lady has pointed out that the illicit market in cigarettes and roll-your-own has diminished significantly since the launch of the first Government tobacco strategy in 2000, with the mid-point estimate of the tax gap for illicit cigarettes decreasing from 21% in 2000-2001 to 9% in 2012-13, for example, according to Her Majesty’s Revenue and Customs data. The UK’s success in reducing illicit tobacco is in no small part due to successive Governments’ commitment to, and investment in, enforcement, and that remains a key part of our policy. We should also see further progress on illicit tobacco on a global scale when the new framework convention on tobacco control protocol on illicit trade is implemented.

The hon. Lady made some interesting points about proxy purchasing. Obviously that is something that, as a new Minister, I have just begun to look at, and I was glad that she explored some of the arguments. I want to emphasise the valuable contribution that the majority of retailers make to ensuring that legitimate tobacco products are sold according to the law, including by not selling tobacco to people under 18 years old. Retailers get frustrated that we hear only about the occasional instances of poor practice that hit the headlines, and that decent, ordinary retailers do not get any credit for the way in which they uphold the law. I want to place on record my thanks to all those retailers who make strenuous efforts to uphold the law and who do not sell tobacco products to children.

I sympathise with the difficulties retailers face in ensuring that they do not make sales to under-age people. I also understand why some retailers feel that buying tobacco on behalf of a child should be an offence. However, we need to think carefully before introducing a proxy purchasing offence. I understand that the supply of cigarettes to children is a problem, but an offence of proxy purchasing would not necessarily tackle the wider problem of supply.

Accident and Emergency Waiting Times

Ian Swales Excerpts

Wednesday 5th June 2013 Commons Chamber

[Mr Hunt]

That is part of the problem with Labour’s approach to the NHS—a top-down approach of closing or downgrading A and E units and making the NHS sort out the problems. We are not doing that.

It is time that Labour took responsibility for the disastrous changes to the GP contract, which contributed to making it so much harder to get a GP appointment and piled further pressure on A and E departments—[Interruption.] No, they need to listen; this is important. The changes in 2004 handed responsibility for providing out-of-hours services to administrators in primary care trusts, at a stroke removing the 24/7 responsibility for patients that until then had always been a core part of being a family doctor. As we heard earlier today, even a former Labour Health Minister regretted those changes, saying before the last election:

“In many ways, GPs got the best deal they ever had from that 2004 contract and since then we have, in a sense, been recovering.”

It is important that Labour Members hear the list of independent voices all saying that we need fundamental change in primary care if we are to deal with pressures on A and E: the College of Emergency Medicine, the Royal College of Physicians, the NHS Alliance, the Family Doctor Association, the head of the Royal College of General Practitioners, who—surprisingly—said something in support of the Government in The Guardian this morning, the Foundation Trust Network and so on. All those voices were ignored by Labour as it put its head in the sand about that disastrous change to the GP contract.

[Ian Swales (Redcar) (LD)]

Does the Secretary of State share my horror that the out-of-hours contracts awarded by the previous Government to companies such as Serco give them a financial incentive to call an ambulance rather than deal with cases through GPs or in the community?

[Mr Hunt]

The system is dysfunctional, and at the heart of the problem is Labour’s creation of a system in which GPs lost round-the-clock responsibility for the patients on their list. That is fundamentally wrong and we need to deal with it.

Mental Health

Ian Swales Excerpts

Thursday 16th May 2013 Commons Chamber

[Andrew Jones (Harrogate and Knaresborough) (Con)]

It is a pleasure to follow the hon. Member for Croydon North (Mr Reed) and other Members from across the House who have given powerful speeches today. I congratulate the Backbench Business Committee on granting this debate and colleagues across the House on requesting it, particularly my right hon. Friend the Member for Sutton and Cheam (Paul Burstow).

This is an important debate because mental health is one of the last taboos in this country. There is still stigma, and that stigma has a devastating impact. The impact is on those who suffer, who can feel isolated and alone, who can face discrimination, who may be reluctant to seek help or the treatment they need and who worry that even suggesting there may be an issue will lead to pressure on families and challenges to careers. So tackling this taboo, removing this stigma, is important, and a way to do that is by encouraging openness, showing that is not just okay to talk about mental health, but right and important to do so. That is why debates such as these are so important.

The last debate we had here on the issue was one of the best I have heard since I started here. Members spoke powerfully and personally, and showed great leadership, particularly the hon. Member for North Durham (Mr Jones) and my hon. Friend the Member for Broxbourne (Mr Walker). Talking about the issue here, in our national debating chamber, helps to change attitudes. It helps those who suffers by demonstrating recognition of their challenges, and it places mental health firmly on the health policy agenda and also on our national agenda.

I have long been concerned that mental health care is a bit of a Cinderella service within our NHS, and that is why I have chosen to speak up about it more than any other health issue locally. Service users are often very vulnerable members of our community and are less able to speak up for themselves. Some of the most challenging, complex and moving pieces of casework I have had to tackle have all involved mental health issues.

Today I shall speak about two areas—dementia care and safe havens. Yesterday I attended the Alzheimer’s Society event in Portcullis House to launch dementia awareness week. Tomorrow I am opening a new care home for dementia patients in Starbeck in my constituency. We all know that dementia is an enormous problem. Every Member will deal with it in their constituency and every family will have to face it at some stage. There are an estimated 800,000 people in the United Kingdom who suffer from Alzheimer’s. In North Yorkshire we have the highest proportion of people aged 85 and over in the north, and we know that one in three people in that age category suffer from some form of cognitive impairment. That is more than 3,000 people in the Harrogate district, but we have a diagnosis rate of only 40% to 45%, so many people suffer without receiving the support they need. The average lifespan in my area for people after a dementia diagnosis is 15 years, so living with and managing the condition is critical.

[Ian Swales (Redcar) (LD)]

I would like to raise a small point about living with the condition on behalf of my constituent, Caroline Simpson, who has dementia but is physically capable of walking a certain distance. Her family have been unable to get a disabled person’s parking badge. This is an example of the problems that occur in living with dementia.

[Andrew Jones]

My hon. Friend makes an important point. The challenges are not fully understood and the support that people need is not recognised. That example is just one of many forms of discrimination that can take place.

In North Yorkshire there have recently been some changes in the way the problem is tackled. The Harrogate Dementia Collaborative has been formed, which brings together different bodies. I have met the collaborative and it has told me of the progress it has made. Bringing good care together really makes a difference. It means bringing together the different providers: the local mental health trust, the foundation trust, social services and the voluntary sector.

A few ingredients have contributed to the progress that has been made: working together to provide that integration, which I have already mentioned, and cross-service working is not always easy within our public services; specialist memory nurses, who were not in place two years ago; a clearer pathway to correct and timely treatment, leading to great progress on waiting times; and a determination to provide care in the home or as locally as possible. I applaud the focus being placed on dementia nationally by the Prime Minister and by Health Ministers, both in this Government and the previous one.

When I meet mental health groups in my constituency, one of the issues they raise with me is the provision of a safe haven, a secure place where people can feel safe, and “safe” is the word that is used time and again. It is a place where they can find understanding of the challenges they face, where there is no stigma and where a supportive environment exists. Such places must be provided by local NHS mental health services, but they can also be supported by the work of the voluntary services. I would like to pay tribute to Harrogate Mind and its team, led by its chair, Mr Peter Thompson. I have visited its base, the Acorn centre on Station parade in Harrogate, and found it to be a friendly and relaxed environment with a fantastic range of activities. Users have told me that they view it as an essential safe place for them. However, the provision of such places is also a public duty, something that must be recognised in the NHS and the police services, as the police are often on the front line in dealing with those who face mental health issues.

Lastly, I have been pleased to see the Government recognise the importance of mental health through publication of their “No health without mental health” strategy. I want to see mental health given the status it deserves.

Oral Answers to Questions

Ian Swales Excerpts

Tuesday 15th January 2013 Commons Chamber

[Norman Lamb]

Yes, I can absolutely reassure the hon. Gentleman that there will be comprehensive services, which will cut across local authorities. We have to remember that local authorities will be under a legal responsibility to provide confidential open access to sexual health services and contraception services. Local authorities in London are aware of the need to ensure that comprehensive services are available from April this year.

[Ian Swales (Redcar) (LD)]

9. What recent assessment he has made of the number of health care appointments and operations which are postponed.

[The Secretary of State for Health (Mr Jeremy Hunt)]

My Department collects data on the number of cancelled elective and urgent operations, which show that these remain very low compared to total activity. We do not collect information on postponed appointments or operations. The NHS must make arrangements locally to minimise postponements and cancellations to avoid the inconvenience to patients.

[Ian Swales]

I thank the Secretary of State for that answer. This is an issue in my area, with the chief executive of South Tees hospital saying that one factor is excessive use of A and E for non-urgent cases, resulting in pressure on hospital resources. What can the Secretary of State do to make sure that A and E units are used only for genuine accidents and emergencies?

[Mr Hunt]

My hon. Friend makes a very important point. I am concerned that 114 non-urgent operations were cancelled in the South Tees area between November and January, which is significantly higher than this time last year. He is right that we need to think about the model for an A and E service. Nearly 1 million more people go through A and E every year than they did two years ago. We have to recognise that for A and E services to be sustainable, we need to think about people who would better off seeing their GP or going to an urgent care centre.

Community Hospitals (North-East)

Ian Swales Excerpts

Wednesday 20th June 2012 Commons Chamber

[Mr Deputy Speaker (Mr Lindsay Hoyle)]

Order. May I suggest to the hon. Member for Redcar (Ian Swales) that if he wants to intervene, it is better if he actually stands up rather than waving his hand?

[Ian Swales]

Thank you for your advice, Mr Deputy Speaker.

I congratulate my neighbouring MP, the hon. Member for Middlesbrough South and East Cleveland (Tom Blenkinsop), on securing this important debate. My daughter was born in Guisborough hospital in his constituency, but that would no longer be possible as the maternity unit closed in 2006. The withdrawal of services from older community hospitals, and the failure to put services into new community hospitals such as Redcar, are top-down decisions. Does he support more locally based commissioning driven by clinicians?

[Tom Blenkinsop]

I believe in an excellent quality of service, and yes, it was regrettable that the maternity unit at Guisborough hospital was closed. As the hon. Gentleman will know, my predecessor fought to save that service. In fact, there was a wide campaign by the local trust and all local politicians to keep it open. Unfortunately, more people opted to use the maternity services at James Cook hospital, which was part of the choice agenda that all parties believe in. I am sure the Minister does as well.

Oral Answers to Questions

Ian Swales Excerpts

Tuesday 27th March 2012 Commons Chamber

[Paul Burstow]

If the right hon. Lady sends me the details, I will look into the individual case. I agree with her that it is unacceptable for such products to be rationed. I think it essential to base their provision on an assessment of individuals’ needs, and for those individuals to receive what they need for a good quality of life.

[Ian Swales (Redcar) (LD)]

My constituent Joyce Benbow was discharged from Redcar hospital last November, but is still there owing to a failure to agree on her care package. When will the managers of health and social care budgets be more joined up so that people receive the right provision at the right time?

[Paul Burstow]

My hon. Friend has raised an important point about the importance of joining up hospital care, community care and social care, which has often been overlooked. We have invested more than £300 million this year in developing more re-ablement services, and in January we invested an extra £150 million in support for them. We are also extending our plans for more tariff reform to ensure that local hospitals have the means to drive the development of such services in their communities.

Oral Answers to Questions

Ian Swales Excerpts

Tuesday 21st February 2012 Commons Chamber

[Mr Lansley]

The hon. Gentleman is going to have to explain why the NHS’s performance is improving, and why it is better than it was at the election. We have cut mixed-sex accommodation, more people have access to NHS dentistry and hospital infections are at a record low. He talks about waiting times. The number of people waiting over a year for treatment has halved since the last election. The total number of people waiting beyond 18 weeks is lower than it was at the election, and the average wait for patients is lower than it was at the election. I am afraid that the premise of his question is completely wrong.

[Ian Swales (Redcar) (LD)]

Following the closure of a specialist ME clinic in Bolton, will the Minister review the narrow NICE guidelines on the treatment of ME, so that patients can get the outcomes that work for them, and so that the doctors providing such treatment are not placed at risk of losing their licence?

[Mr Lansley]

My recollection is that NICE itself is undertaking a review of the guidelines relating to the commissioning and provision of services for ME. I will check to ensure that that is the case, and if I am wrong I will of course correct the record. I will write to the hon. Gentleman in any case. It is not for Ministers to write NICE guidelines; that is a matter for NICE to deal with independently.

Health Inequalities (North-East)

Ian Swales Excerpts

Tuesday 24th January 2012 Westminster Hall

[Ian Swales (Redcar) (LD)]

It is a pleasure to speak under your chairmanship, Mrs Riordan. I congratulate the hon. Member for Newcastle upon Tyne Central (Chi Onwurah) on securing the debate. I agree with her that the issue of health inequalities is of great importance to all MPs and particularly those of us who represent constituencies in the north-east. Having been born in Leeds, I was delighted to emigrate to the north-east in my early 20s.

First, I would like to refer to the July 2010 National Audit Office report, which was specifically about “Tackling inequalities in life expectancy in areas with the worst health and deprivation”, and to the subsequent hearing of the Public Accounts Committee and the report that it produced in November 2010. That report was in effect a catalogue of action by the previous Government and bears detailed reading. It said that the Department of Health had been

“exceptionally slow to tackle health inequalities…we find it unacceptable that it took it until 2006—nine years after it announced the importance of tackling health”—

[Grahame M. Morris (Easington) (Lab)]

Will the hon. Gentleman accept that tackling health inequalities effectively requires a broad range of actions, including tackling things such as educational under-achievement, the need for warm homes, and child poverty, which go across a broad range of Departments, not just the Department of Health?

[Ian Swales]

I absolutely agree with that and will go on to say more about it. The Department of Health has an important role in being the umbrella Department for monitoring action in this area, however. The report went on to say that the Department recognised its failings, admitting that it had been

“slow to put in place the key mechanisms to deliver the target it had used for other national priorities”

and

“slow to mobilise the NHS to take effective action.”

However, I agree with the hon. Gentleman that there is much more to this than simply the NHS.

There certainly has not been a shortage of reports on this subject. The Department of Health issued 15 major publications on the issue, starting in 1998 and rising to a crescendo in 2010. In fact, 2007 was the only year in which the previous Government did not issue a publication.

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

I wonder whether the hon. Gentleman could catalogue the action that was taken after the publication in 1980 of the Black report, which first demonstrated a causal link between ill health and poverty. In addition, “The Health Divide” was published towards the end of the ’80s. As I recall, because I was working in this field, there was absolutely nothing.

[Ian Swales]

I bow to the hon. Lady’s knowledge in this area. She certainly has a great deal more than I do. I do not know the answer to her question.

In 2003, the Government identified 12 cross-Government headline indicators and 82 cross-Government commitments, but sadly overall it was effective action that was the problem. In 2005, the Government identified 70 spearhead local authority areas for special attention, and credit to them for that. One third of those areas were in the north-east. However, only in London did those spearhead areas see a narrowing of health inequalities.

I know that this issue is complex, but some things are basic. The NAO report showed that more deprived areas had fewer GPs. Some had significantly fewer. They were also paid less. I was shown barely believable figures showing that Redcar and Cleveland had only half the average GP resource of the most deprived 20%. Clearly, that is not a good position to be in.

[Ms Diane Abbott (Hackney North and Stoke Newington) (Lab)]

How does the hon. Gentleman think that forcing through NHS reforms that are vehemently opposed by both the British Medical Association and the Royal College of General Practitioners will encourage GPs to go and work in deprived areas that have a shortage of GPs?

[Ian Swales]

I believe that the wider issue of NHS reforms is outside the scope of this debate, but certainly I see a growth in the number of GPs already.

[Chi Onwurah]

rose—

[Ian Swales]

I am not giving way again on that subject.

As the hon. Member for Easington (Grahame M. Morris) said and as we all know, many factors are involved in health inequalities: smoking, alcohol, obesity, housing, income and others. Sadly, the area that I represent has the worst rate or one of the worst rates of obesity in the country, and one third of my constituency is in the poorest 10% of most deprived wards, so I am well aware of how these things operate in the local area.

In the public health area, we should, as the hon. Member for Newcastle upon Tyne Central said, celebrate a great success and learn from it. The Fresh organisation has had a great impact in terms of smoking reduction. The rate in the north-east went from 29% in 2005 to 22% in 2009. I also find this hard to believe, but apparently males in the north-east have the lowest rate of smoking in the country. It was probably the highest at one time, but apparently it is now the lowest. That shows that effective public health action and education can have a big impact. Models such as that, in which innovative third sector organisations focus on change, can assist with this important job, which is a lot about behavioural change.

As well as successes such as the one that I have described, I welcome the increased spending in the NHS by the previous Government. That has increased health outcomes for all, regardless of the fact that it failed to narrow health inequalities. My area has seen the setting up of excellent facilities such as the James Cook university hospital. As has been mentioned, there is also the data gathering, which is so important in learning how to deal with these problems.

There is still a lot to do. In my constituency, there is a 16-year gap between the life expectancies in the richest and poorest wards. I therefore welcome local health commissioning, which will lead to a more joined-up approach to local issues. An excellent pathfinder GP group is already up and running in Redcar; in fact, it was running as a social enterprise for five years before the recent reforms were introduced.

I welcome the public health agenda and the fact that the budget will go to local authorities. I also welcome the setting up of health and wellbeing boards, although we will have to watch how the money is spent to ensure that the maximum amount gets to the front line. Similarly, I welcome the proposed establishment of Public Health England, which will have the specific aim of reducing health inequalities.

Even more study is needed into, for example, the psychological aspects of why people choose lifestyle options they know to be harmful. Recent research clearly shows that many social problems, including the one we are discussing, stem from income inequality, not from absolute levels of income, and some interesting data are emerging. Sadly, income inequality also widened under the previous Government.

The new Government have made a start, but there is much more to do, and I look forward to the Minister’s comments.

--- Later in debate ---

[Mr Iain Wright (Hartlepool) (Lab)]

It is a pleasure to serve under your chairmanship, Mrs Riordan. I apologise for turning up late to this debate. I was chairing another meeting, which I was obviously doing badly because we overran our time.

I congratulate my hon. Friend the Member for Newcastle upon Tyne Central (Chi Onwurah) on securing this debate, which is on one of the most important issues facing the north-east. The health inequalities in my own constituency are certainly unacceptable. For many years, the health of the people in Hartlepool has generally been worse than the national average. Although progress has been made, health levels remain too low and are not improving fast enough for many of my constituents.

Life expectancy in Hartlepool is lower than in the rest of the country. A boy born in Hartlepool today would expect to live until he was 75.9 years old, which is two years shorter than the national average. A girl born in Hartlepool would expect to live until she was 81 years old, which is longer than her counterparts in Middlesbrough, Gateshead, South Tyneside or Sunderland. None the less, her life expectancy is still more than a year shorter than the national average for girls and women.

Those figures have improved dramatically over the past 15 years, which reflects increased health funding, more investment in primary care, a greater emphasis on prevention and rising living standards. However, there are several worrying elements within the data. First, generally rising life expectancy rates mask huge inequalities within Hartlepool that simply should not be tolerated in a civilised society. A constituent of mine living in Stranton, Dyke House or Owton Manor would expect to die up to 11 years earlier than a similar constituent living in the area close to Ward Jackson park.

Secondly, the mortality rate for women of all ages has fallen across all parts of the country, with the exception of those in my constituency. Data show the contrasting fortunes of different local areas. In the decade after 1998, the mortality rate for women in Kensington and Chelsea fell by more than 40%, but it barely moved in Hartlepool. I suggest to the Minister, who has some experience of Hartlepool, that women in my constituency consider the health of their children and family over and above their own. What can she do to address that cultural issue, so that the caring nature of Hartlepool’s womenfolk is retained, but not at the expense of their health?

Thirdly, much behaviour in Hartlepool leads to poor health outcomes. For example, estimated healthy eating, smoking rates and obesity are significantly worse than the England average. Although deaths from heart disease and strokes in Hartlepool have fallen, they remain well above the national average, while death rates from cancer remain some of the worst in the country. Hip fractures for people in Hartlepool aged 65 and above are off the scale by comparison with other areas in England. Why? It is mostly because of our place in history and the manner in which we have been affected by de-industrialisation.

Given our legacy as a place of heavy manufacturing, we have a disproportionate amount of people suffering from industrial diseases and injuries. I particularly want to highlight the number of chest-related diseases. The number of people suffering from asbestos-related diseases such as pleural plaques and mesothelioma is heartbreaking. The present Government’s delay in setting up any response to deal with those cases is prolonging the suffering for many constituents and their families. I urge the Minister to speak to her counterparts at the Department for Work and Pensions and the Ministry of Justice to ensure that the employers’ liability insurance bureau is established as quickly as possible.

[Ian Swales]

rose—

[Mr Wright]

If the hon. Gentleman will forgive me, I will not take interventions because a lot of my hon. Friends want to contribute to this debate.

I mentioned the de-industrialisation of the past 30 years. The loss of the shipyards, the docks and many of the steelworks and our engineering firms has hit Hartlepool’s prosperity hard. As my hon. Friend said, there is a very clear correlation between income, employment and health. Given the bad and deteriorating economic situation in my constituency and the wider north-east, the Minister needs to be mindful of the implications on health of the Government’s economic policy.

As unemployment in the north-east and in Hartlepool is high and rising, and there is a direct link between being unemployed and being unwell, the significant health inequalities that my constituents experience will only get worse. Only this week, the Centre for Cities highlighted a growing divide between northern cities and their southern counterparts in prosperity, innovation and resilience to an economic downturn in 2012 and beyond. That is bound to have a worsening effect on health inequalities, whether physical health or mental well-being.

The Minister will recognise the direct link between economic policy and health inequalities. How will she combat the health fall-out from the failures of the Chancellor’s economic policy and the neglect of the north-east? The problem will be made worse by the Chancellor’s announcement in the autumn statement to regionalise public sector pay. That will have enormous repercussions on the NHS in the north-east. Although highly professional, the NHS in the region is already struggling to recruit and retain appropriate staff tasked with addressing health inequalities in our region. Health services are already under strain not merely because of budgetary pressures, but because of difficulties in recruitment.

My hon. Friend the Member for Tynemouth (Mr Campbell) mentioned difficulties in attracting and recruiting GPs. My area has one of the lowest GP per capita rates anywhere in the country, and that does not help to reduce health inequalities. Does the Minister not think that that problem and therefore health inequalities will get worse under the Chancellor’s proposals for regionalised pay, and how will she counteract it with regards to recruitment and retention in the NHS?

Let me refer to the ongoing saga of the University hospital of Hartlepool. The Minister will be aware of the closure of accident and emergency last year, which no one in Hartlepool wanted. It has been announced recently that some services will migrate back, which is very welcome, but the whole health economy in my area and, by implication, the health inequalities in the region remain uncertain because of the lack of a clear decision about the new hospital and its funding arrangements.

Will the Minister today provide some clarity about what will happen with regards to the future provision of a hospital in Hartlepool? I do not want to take away the welcome news of a new hospital for the constituents in Hexham, but what about my constituents in Hartlepool? Will she reconsider the proposals put forward by Lord Darzi five or six years ago? In short, can we have clarity with regard to the ongoing provision of a hospital in Hartlepool?

We in the north-east and in Hartlepool have suffered for far too long with disease, ill health and early death, much of which is linked to deprivation and poverty. Government policy threatens to make that worse, so I hope that the Minister can provide us with some reassurances this morning.