Health Inequalities (North-East)

Jim Shannon Excerpts

Tuesday 24th January 2012 Westminster Hall

[Chi Onwurah]

I thank the hon. Gentleman for his intervention. As I said, the causes of health inequalities are complex. Alcohol dependency certainly varies significantly throughout the country. We need, and we are seeing, targeted campaigns to address that. I hope that the Government will introduce concrete measures to address alcohol dependency, such as legislation and a minimum price if that is appropriate.

Labour prioritised addressing health inequalities. We could not overcome the legacy of inequality in 13 years, but we made real progress, as the figures for infant mortality show. However, that is set to change. There are three main ways in which the Government are undermining work to reduce health inequalities.

First, the Government have changed the funding formula, and reduced the component designed to address health inequalities. I have been in Parliament for 19 months, and I have raised this matter directly with Ministers four times, not counting written questions. I am hoping it will be fourth time lucky for receiving a direct answer. Will the Minister confirm that in 2010 the Secretary of State decided, against the advice of the Advisory Committee on Resource Allocation, to reduce the health inequalities component of the primary care trust target funding allocation from 15% to 10%? Two weeks ago, during an exchange on the Floor of the House, the Secretary of State cited a 2.8% rise in funding when I asked him about changes to the funding formula. Will the Minister address the change to the formula, rather than the overall increases that the Government claim?

During a speech on the Floor of the House in December 2010, I asked the Secretary of State to confirm that more will be invested in health services for every man, woman and child in Newcastle for every year of the comprehensive spending review as the Government claim that they are increasing NHS spending. He declined to do so, so will the Minister step into the breach?

Clearly, if funding is changed to reduce the amount associated with health inequalities, the north-east will lose out. The Minister will say that the Government have ring-fenced public health spending and handed it over to local authorities. She may refer to the public health outcomes framework, which was published yesterday, just in time for today’s debate, and is very interesting reading. It includes 66 measures, which will be monitored, but they cannot distract from the assault on public health that the Government’s wide-ranging cuts represent for local authorities. For example, cuts to fuel poverty reduction programmes such as Warm Front will leave pensioners in Newcastle colder and more vulnerable to illness. Cuts to area-based grants such as the Supporting People programme mean there will be less investment in support services for those with mental health issues.

The second way in which the Government are undermining work to address health inequalities is the top-down, unnecessary and destructive health care reforms. It is estimated that they will cost £3 billion, and we now know that in the north-east the NHS has been asked to put aside £143 million for those organisational changes. The Government claim that efficiencies will make up for that, but the service is already being asked to meet the 1.5% efficiency cuts challenge at a time of wholesale reorganisation. As the Select Committee on Health said today, it is incredibly difficult, if not impossible, to make such efficiency savings when everything is changing.

In the north-east, our strategic health authority and primary care trusts are being abolished. Funding will be in the hands of GP consortia. Newcastle already has a pathfinder consortium in place. Newcastle Bridges GP commissioning consortia covers most of the city, and has shown that it is keen to work with other stakeholders across the city to promote public health, but it is having to make it up as it goes along in the face of huge uncertainty and change in the public sector and in the third sector, with unprecedented local authority cuts, watched over by an eager private sector that is keen to take advantage of the profit-making opportunities that the Prime Minister and the Health Secretary have promised.

A recent letter to the Health Service Journal, signed by more than 40 directors of public health and more than 100 public health academics, argued that the Bill will increase health inequalities, not reduce them. If the Government will not pay attention to what the Opposition say, perhaps they will pay attention to what the profession says. Michael Marmot told the Health Committee that there is little evidence that the health premium will reduce inequalities. Indeed, he said that it is most likely to increase them. Seven former presidents of the Faculty of Public Health have said that the Bill will “exacerbate inequalities”.

[Jim Shannon (Strangford) (DUP)]

I congratulate the hon. Lady on bringing this matter to the Chamber. I am a Member not for the north-east, but for Northern Ireland, where health is a devolved matter, but she is expressing concerns felt by many people throughout the United Kingdom, even where such matters are devolved. There are two reasons for that. The problems for her constituents, to which she referred, are as real in my area as they are in other areas of the United Kingdom. The Government’s reduction in the block grant for Northern Ireland means that our health will also be affected. The changes in health care here will be the marker for future changes for us. Does she believe that the service that the NHS is offering is not the standard that we in the United Kingdom expect and are accustomed to, and is not of the standard that is needed to address core health issues?

[Chi Onwurah]

I thank the hon. Gentleman for his intervention. I believe strongly that the national health service is one of the best, most efficient and most effective health services in the world. The evidence shows that, as I will explain. It is absolutely right to say that the concerns I am expressing on behalf of my constituents and the north-east are felt throughout the country, and with good reason. The proposed measures will have an impact on the health of all constituencies in the country. The profession believes that the changes will have a negative impact on health inequalities. The Health Committee’s recent report on public health warned that the Bill poses a “significant risk” of widening health inequalities, yet the Government are pressing ahead.

The third way in which the Health Secretary will widen regional health inequalities is through the wholesale marketisation of the national health service. Before the Minister pretends otherwise, let me quote her colleague, the Minister of State, Department of Health, the right hon. Member for Chelmsford (Mr Burns), who admitted last year that the Bill will turn the NHS into a “genuine market”.

We should recognise that despite having serious health inequalities, we suffer relatively little from inequalities of access. I am no expert on health services, but I am told by those who are that the stent insertion that Prince Philip recently underwent at Papworth hospital did not differ materially from the treatment that any of my constituents would have received at the Freeman hospital if they had suffered a similar condition. That is fantastic, but it is not the case in the United States of America where there are terrible health access issues due to its private health care system. In the short term, the Government’s reforms are diverting funds away from patient care, which will have an impact on waiting times. Those who can afford it will tend to seek private health care, but those on low incomes will be unable to do that. In the longer term, the Bill is about the privatisation of the NHS. Strong independent evidence indicates that the NHS is one of the most efficient and equitable health systems in the world. Why would we want to make it into a market? The Bill misses an important opportunity to focus on the real issues and the wider determinants of health in this country.

I shall therefore finish by asking the Minister these questions. The Government have signed the recent World Health Organisation declaration to deal with the social determinants of health inequalities, so what concrete actions will Ministers take? The previous Government accepted the Marmot review’s recommendations in full. When will the current Government do the same? What are the coalition’s proposals for introducing a national minimum unit price for alcohol? Will the Government confirm a commitment to undertake a consultation on plain and standardised packaging for tobacco products, and on what date that will take place?

Does the Minister share my concern about the Royal College of Midwives and Netmums survey showing that women from lower incomes were denied antenatal classes and the choice of a home birth? Will that not entrench health inequalities from before birth? The Minister looks somewhat surprised at that question, but differences in health access do exist in our country.

As Blane said, no law of nature decrees that the children of poor families should die at twice the rate of children born into rich families. In the north-east, there are more poor families. Will the Government commit to reversing their changes to the funding formula component designed to deal with health inequalities?

The national health service’s first Minister of Health, Nye Bevan, famously said that when a bedpan falls to the floor in Tredegar, it should echo in the Palace of Westminster. The Minister of State, Department of Health, the right hon. Member for Chelmsford, quoted that with some amusement and disdain and proclaimed that those days were long gone, so what does this Minister think should echo in Westminster? Does she accept responsibility for reducing health inequalities? Can she assure me that health inequalities between the north-east and the rest of the country will reduce over the term of the present Government?