Health Inequalities: North-west London

Neil O'Brien Excerpts

Monday 15th May 2023 Commons Chamber

[The Parliamentary Under-Secretary of State for Health and Social Care (Neil O’Brien)]

Well, how to follow that? I pay tribute to the hon. Lady for securing this important debate and for her wide-ranging speech. It was so wide ranging that I think I will struggle to follow or match it, but I will do my best. It was a speech with everything from Tina Turner and Bruce Springsteen to loneliness and ethnic minority participation in clinical trials. Let me try and structure my response by starting with the health service, working back to primary care, and then addressing public health.

The first and most central thing is, of course, to have a high standard of healthcare. That is why, between 2010, when we came into office, and the end of this Parliament, we will have increased spending on healthcare by 42%, even when adjusted for inflation. That has enabled us to hire about 37,000 more NHS doctors than there were in 2010, and 52,000 extra nurses. That is a huge increase in resource and people, enabling us to start hacking through the covid backlog. We have already eliminated the two-year waits and have very nearly eliminated the 78-week waits. We are now moving on to eliminate shorter waits as we work through and cut the NHS waiting lists.

Of course, that is downstream—that is secondary care, hospitals and treating disease—and we all agree that the name of the game is to try to prevent disease and to treat things upstream, which is why we made further investments in primary care last week. In general practice, we have about 2,000 more doctors than we had in 2019 and about 25,000 more other clinicians. Compared with 2017, total spend on general practice is nearly a fifth higher. So more resource is going into that primary care.

We also see primary care doing more than ever. GPs are doing about 10% more appointments every month than they were before the pandemic, in 2019. That is the equivalent of about 20 extra appointments per practice per working day, which is a huge increase in output. That is partly because of the extra resource and partly because GPs are working extremely hard, and I pay tribute to everyone in general practice for doing that. That activity in general practice is a big part of the prevention story, helping people to stay healthy and to stay out of hospital.

However, as the hon. Lady alluded to, a lot of health is about the social determinants of health and about getting further upstream and tackling the underlying causes of the disparities that she talked about with great passion and understanding. Taken together, the public health grant, the drugs grant and the Start for Life grant will grow by about 5% in real terms after inflation over the next two years, enabling us to do more, particularly on problems such as drug dependency and drug addiction, which are particularly serious across all of London.

Part one is to have the funding there for those streams, but we have also been making major institutional changes to public health. We have set goals to increase healthy life expectancy and to the narrow gaps between different parts of the country. We have created the Office for Health Improvement and Disparities, and we and the NHS have created the Core20PLUS5 framework, which is a way of thinking about and tackling disparities. We have also put a new duty on integrated care boards to have due regard to disparities and to try to tackle them.

In quite specific ways, we have been taking action—this is of course relevant to north-west London—to tackle the problems of particular ethnic minority groups. In particular, we have been driving up vaccine uptake, particularly in groups where there is a degree of hesitancy, through targeted advertising and outreach to faith groups and local community groups, and I pay tribute to everyone who has been involved in that in the NHS.

We have been tackling the challenges thrown up by energy, which I will come back to, and by social housing—the hon. Lady was quite right to raise that issue in relation to west London. I pay tribute to my right hon. Friend the Secretary of State for Levelling Up, Housing and Communities for the vigorous action he is taking to tackle some of these challenges through the Social Housing (Regulation) Bill and extending the decent homes standard to the private sector, and the action he is taking to make developers pay to clean up the mess they have caused and to make sure we never have a Grenfell again.

So action is being taken across a wide range of areas. Let me just delve into a few of them in the time remaining. On drugs, the Home Office, the Ministry of Justice and the Department of Health and Social Care are investing about £900 million extra in the drugs strategy, which will grow local authority funding for treatment by about 40% between 2021 and 2024-25, and create about 50,000 extra places in treatment. As well as that investment in more treatment for people with drug addictions, we are increasing access to naloxone, which helps treat overdoses, and looking at spreading new technologies and new treatments, such as slow-release buvidal. When I visited a health centre in Brixton I saw the effect that some of these new drugs can have on improving treatment for those who have serious drug dependencies.

However, again on the point about getting upstream, our Start for Life programme is a major investment in new and expanded family hubs in about 75 local authorities. Its universal offer in those areas combines peer support for breastfeeding, help for those who are difficult to help and lots of face-to-face support with issues such as mental health. Right from the very start, as the hon. Lady mentioned, this is about trying to improve the disparities that emerge at an early stage.

Across the course of life we are taking action to prevent some of the most important major conditions, and our major conditions paper, which succeeds the health disparities White Paper will say more about this. The NHS long-term plan already announced the ambition to prevent 150,000 heart attacks, strokes and dementia cases by 2029. We supplied about 220,000 blood pressure monitors to those with high blood pressure. We are modernising and updating the NHS health check and creating a digital version. We have already pretty much got back to pre-pandemic levels of health check. We will be setting out more about the prevention of these major conditions in that forthcoming paper.

[Dr Huq]

The Minister is giving a constructive response with a lot of numbers in it. Is there a date for the major conditions strategy? I have asked him before and we have sparred on this question. At the time of the health disparities White Paper, the Secretary of State at the time—just two Secretaries of State ago—said that we should level up health as well as levelling up economically. The strategy does feel like a watering down, and it is yet to see the light of day. Do we know when it is coming out?

[Neil O’Brien]

There is not actually a date for that paper yet, but it will be out relatively shortly. We are tackling the major conditions because these health disparities that we are all concerned about are not mediated by magic; they are mediated by physical things that happen. First among them is probably smoking.

Smoking rates are highest in the poorest places, and that is a powerful driver of all of these other major health problems. I am proud to say that we have the lowest rate of smoking on record in England—just 13%, down from 21% in 2010—and that has happened because we have doubled duty on cigarettes and introduced the minimum excise tax on the cheapest cigarettes, and we have recently announced measures to go further. We are offering a million smokers help to “Swap to stop”, as they say, by giving them free vape kits, because that is so much less harmful, and we will also be introducing a financial incentive to quit, worth about £400, for all women who are pregnant and smoking. A shocking number of people still smoke in pregnancy, particularly in areas of higher deprivation. That builds on some of the things that the NHS is already doing, including the roll-out of carbon monoxide testing for people who are pregnant and smoke, and some of the innovative things that have been done at a local level.

The other big way that these health inequalities are mediated is through obesity. There are much higher rates of obesity in poorer places, for the reasons that the hon. Lady set out. She already mentioned some of the things. She talked about the so-called sugar tax—the soft drinks industry levy, as not a single person ever calls it—which has cut average sugar content in affected drinks by about 46% since we brought it in. We have introduced calorie labelling for out-of-home food in cafés and restaurants, and brought in location restrictions for less healthy food from October 2022. We are bringing in an advertising watershed in 2025. We spend about £150 million a year on healthy food schemes, such as school fruit and veg, nursery milk, Healthy Start and so on. We spend about £330 million a year on school sport and the PE premium. Through the youth investment fund, we are spending about £300 million on 300 new facilities for youth activities. We are also investing about £20 million a year on the national child measurement programme, which is all about trying to note these problems at an early stage and nip them in the bud.

In the hon. Lady’s speech, she talked about the challenges thrown up by the Russian invasion of Ukraine and the effect that has had on the cost of living. Again, we are taking decisive action. We are spending about £55 billion to help households and businesses with their energy bills, which is among the highest and most generous support plans in Europe, paying about half of people’s bills over the winter. On top of that, we have action directly to help with the cost of living for people who are less well off, including the £900 cost of living payment for about 8 million poorer households and the largest ever increase to the national living wage for 2 million workers. In total, we are spending about £26 billion on cost of living support next year. We are taking action on energy, but also at the same time taking further action both to improve the quality of rented and social housing through the Social Housing (Regulation) Bill and to invest more in energy efficiency so that people’s homes are cheaper to heat.

I have tried to tackle some of the subjects that the hon. Lady raised in her speech, which I thought was really interesting to listen to and covered many subjects. I will not be able to tick all of them off this evening, but it was a pleasure to hear about some of her thoughts and ideas, and a pleasure to commend to the House some of the action we are taking.

Question put and agreed to.