Health

Paul Williams Excerpts

Tuesday 14th May 2019 Commons Chamber

[Matt Hancock]

No. I agree with the hon. Gentleman about the importance of clean air, but I gently point out that dealing with the deficit—the annual amount by which the Government was overspending—is, and must be, the precursor to getting the debt down. Now, thankfully, the debt is falling relative to the economy, but there has been an awful lot of hard work to get us there.

Let us look at some of the things the NHS is delivering. The entire population now has access to evening and weekend GP appointments. More than a million GP appointments a month are now booked online, and consultation increasingly takes place online. More than three million repeat prescriptions are done online. There are more than 2 million more operations a year than in 2010, and we see 11.5 million more out-patient appointments than in 2010. Since last year, more than 500 extra beds a day have been freed up in hospitals.

When it comes to the future, only yesterday we announced that a new treatment aid for brain cancer can be rolled out across the country, benefiting up to 2,000 patients, all because of the extra money we are putting in. My right hon. Friend the Member for Wokingham (John Redwood) is quite right that in return for the extra taxpayers’ money we are putting in, we must get extra out, too.

[Dr Paul Williams (Stockton South) (Lab)]

Extra investment in the NHS is welcome, but when will the Secretary of State start talking about health visitors, school nurses, drug treatment services and other services funded out of the public health grant—the topic of the debate?

[Matt Hancock]

The public health grant is settled in the spending review. The NHS settlement has come before the spending review, and the public health grant is only one part of the approach to public health. In 2015, this House agreed, with broad acceptance across parties—I know the hon. Gentleman was not in the House then—that local authorities should take responsibilities for public health, to ensure that the entirety of local authority activity could be focused on better public health.

Public health is not just what happens in the NHS, with councils or in GP surgeries or hospitals. For instance, the Government have taken a global lead in getting social media companies to remove suicide and self-harm content online because of the danger that poses to people’s mental health, and in particular that of children and young people. That is a public health issue. Likewise, the efforts we are making to reduce air pollution in the environment Bill—a broader piece of legislation than just a clean air Act—are about a public health matter. It is not in the public health grant, but it is a public health matter.

--- Later in debate ---

[Dr Paul Williams (Stockton South) (Lab)]

It is a pleasure to follow my colleague the hon. Member for St Ives (Derek Thomas), who serves with me on the Health and Social Care Committee. I warmly welcome the new Minister to her place, but if she thought she would learn about public health in the debate, she will be sadly disappointed. I and Opposition colleagues have sat and listened to Government Members talk about anything other than public health. It is so disappointing that Government Members do not seem to know what public health is.

I really care about public health. I care about it so much that, after spending five years training to be a doctor and another four years training to be a GP, I did a master’s degree in public health. It is so important because it is about health inequalities and the massive gap in life expectancy, which we are seeing increasing. I represent the town of Stockton-on-Tees, where the life expectancy gap between men living in the most deprived areas of town and those in the wealthiest is more than 11 years; for women, it is more than 16 years. Much of that is because of the inverse care law that tells us that the people with the highest need are those least likely to access healthcare. Those with the highest need for cervical screening are least likely to access it. Those with the highest mental health problems are less likely to access those services. Those with the highest needs for smoking cessation services are least likely to access them. Investment in public health makes economic sense, because prevention is better than cure, and it makes really good social justice sense.

Tempting as it may be to invest in another building or buy another machine that goes ping, the real difference that can be made to health inequalities and public health comes right at the beginning of life. The first 1,000 days are where most health inequalities are sown. It was a privilege recently to chair the Health and Social Care Committee’s inquiry on the first 1,000 days of life: a time when developing brains make a million new connections every single second. If we get it right then, we can build healthy minds and healthy bodies, but if we get it wrong, that can cause all kinds of problems.

The fact is that more than 8,000 children in this country live in homes with the triad of a parent with a mental health problem, a parent with substance misuse problems and domestic violence. What intervention will make the real difference? How can we help those children? That is done largely through the work of health visitors, and I am afraid that since public health funding and the responsibility for public health was transferred to local authorities, we have seen a cut of 2,000 health visitors employed by the NHS and 1,000 Sure Start centres have closed.

These are the things that make the real difference. They make a difference to breastfeeding, of which our rate is one of the lowest in Europe; to child mortality, our levels of which are much higher than those in comparably rich countries; and to detecting the hidden half of women with perinatal mental health problems who say they were not detected by health services.

I hope that it has not been a deliberate strategy to disinvest from these important services. I think that it has happened by accident. Either way, we have to make a difference; the situation must be rectified. I welcome the work of the cross-departmental ministerial working group that the Leader of the House is leading, and I hope that the new Minister is lobbying the Treasury and making a passionate case for investment at the start of life.

[Liz Twist (Blaydon) (Lab)]

My hon. Friend is making a powerful speech about the importance of public health, especially in the early years. In Blaydon, which is part of Gateshead Council, the public health budget has reduced by 15% since the transfer of health visitor services, which has led to the loss of services that make a big difference to people on the ground. Is it not a shame that we are losing vital public health services?

[Dr Williams]

It is painful that that is happening in places such as Blaydon, where life expectancy is declining. Life expectancy in the north is declining, and there are huge life expectancy gaps between north and south. It is the very part of the country where we should be investing in public health, not making cuts. In Stockton-on-Tees, public health has been cut by £1 million in the past two years.

What do we want? It is 10 years since the Marmot review set out the evidence base for how to reduce health inequalities. We should be doubling down on investment in health inequalities. We should be investing in sexual health services. We should be investing in drug treatment services, which nationally have been cut by 16.5%. Instead, we see year-on-year funding reductions, public health is being cut to the bone, life expectancy is falling and health inequalities are rising. The Government need to show an absolute commitment not just to treatment services but to grassroots prevention services in communities up and down the country, and they must invest properly in public health services. Local authorities are the right place for them to be, but they have to be properly funded and supported.