Austerity: Life Expectancy

Philippa Whitford Excerpts

Wednesday 18th April 2018 Westminster Hall

[Andrew Selous (South West Bedfordshire) (Con)]

I pay tribute to the hon. Member for Sheffield, Heeley (Louise Haigh) for bringing this important matter before the House.

I will start with the economics, because the debate relates to austerity and life expectancy. Government Members would probably talk about living within our means and would put to the hon. Lady the argument that the consequences for the poor and the vulnerable of a country continuing to live beyond its means are very grave. Economic history tells us that when countries lose control of their finances, it is not the well-to-do or the comfortable who suffer, but the poor and the vulnerable. That needs to be put very firmly on the record.

It is also worth noting that the Commonwealth Fund, which is an independent body, last year pointed out that our NHS was the best health system of the 11 different health systems it looked at. If we look at our outcomes on strokes, heart attacks and cancer, we see that they are getting better—there are 7,000 people alive today who would not be alive had we not seen that improvement in cancer outcomes.

Looking at the data across Europe, we see that what is happening in the UK is part of a trend, because life expectancy is also falling in Italy, Spain, France and Germany. Some of those countries spend quite a lot more on health than we do. France and Germany spend one percentage point of GDP more on health than we do, yet they have also seen that downward trend.

[Dr Philippa Whitford (Central Ayrshire) (SNP)]

Will the hon. Gentleman give way?

[Andrew Selous]

I will in a moment. There has been no austerity in Germany, because the Germans live within their means and run a big budget surplus. They have a trade surplus with China. However, life expectancy is falling in Germany as well. We need to look at these wider factors and at the European context. I will now of course give way, with great pleasure, to my former colleague on the Health Committee.

[Dr Whitford]

Does the hon. Gentleman also recognise from the data that there is not a similar fall in life expectancy in the Scandinavian countries and that it is wrong to look narrowly at health services, because the biggest driver in relation to life expectancy is poverty?

[Andrew Selous]

I will come on to those very important public health issues and what we need to do about them, because I care passionately about them, as probably everyone in the Chamber does. As the hon. Lady is from Scotland, it is also worth looking at what is happening there, because Scotland offers free adult social care and spends a higher amount on healthcare per head than England, yet still has a lower life expectancy than England. We need to get those issues firmly—

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[Dr Philippa Whitford (Central Ayrshire) (SNP)]

The hon. Member for Sheffield, Heeley (Louise Haigh), whom I commend for securing the debate, spoke a lot about the impact of austerity on health and social care. To pick up on that, I should say that austerity has a triple impact. Spending on health and social care ends up being strangled, as we have seen: the reduction of the annual climb in expenditure from 3.5% to approximately 1%.

Of the two other impacts, one is the economic impact that we have faced ever since the crash at the end of the 2000s and which has been felt throughout Europe—I have a German husband, and I can tell you that while Germany itself may have a surplus, there are people there who are struggling and have not seen the wage rises that they would have liked. Also, in this country especially, we have seen welfare cuts, which have removed social security from people, creating particular areas and populations of poverty. That has particularly hit the disabled, children and pensioners.

There has been a lot of talk about healthcare. After 33 years as a doctor, I have to say that we can have far too much faith in what medicine can do to change overall life expectancy. We have some impact, but the biggest driver of ill health and the biggest impact on life expectancy is poverty and deprivation. That is something we have seen increasing in this country.

For example, over the past 20 years the rate of pensioner poverty dropped 28% to 13% by 2011-12, but it has now come back up to 16%. Twenty years ago in England, child poverty started out at 33%, got down at best to 27% in 2011-12, and is now back up at 30%. In fact, Scotland has the lowest rate in the UK: we started at a similar level, got down to 21% in 2011-12, and are still the lowest, at 24%. However, we have seen the same uplift, and that is because of aspects of social security and the impact of things such as the removal of child tax credits or the cuts to all the various social security supports. Over the past few years, similarly, poverty in general has risen slightly in England, Wales and Scotland, although Scotland has the lowest poverty rate, at 19%.

Important impacts of poverty on health include housing and fuel. People in the lowest 20th will be spending a third of their income on housing and, in the north of Scotland, another third on fuel. People are literally being squeezed and are struggling to eat well, which of course impacts on their health. We can see big differences in wealth across the UK. There is approximately twice the wealth in Kensington and Chelsea as in Glasgow—as well as more than 10 years’ difference in life expectancy.

As has been mentioned, the improvement in life expectancy has halved, from three months to approximately six weeks, although in Scandinavian countries the improvement continues, because social support and the social fabric is something they invest in. In Scotland the life expectancy deprivation gap has narrowed from 13.5 years to nine. That gap can, in the raw sense, be influenced by healthcare—we manage to keep people alive—but we are not keeping people healthy. They are surviving but accruing more and more diseases. In Scotland, therefore, the healthy life expectancy gap has increased from 22.5 years to 26 years. People are struggling with all of that, and it results in a much higher health spend and much more pressure on the NHS. That is exactly what Members have been saying: there is no sensible saving of money if it ends up being spent somewhere else.

Infant mortality is a measure of the impact of poverty on health that is used right across the world. For three decades, infant mortality had been dropping; it has now taken a small uptick. In Scotland, again, we have the lowest infant mortality rate—0.5 per 1,000 live births lower than in England—but it too has gone back up. Look at the contrast between the wealthiest and poorest areas: in the wealthiest areas, just over 2.5 babies per 1,000 live births will die within a year; and in the poorest areas the rate is more than double that, at 5.9 per 1,000 live births. Read Professor Marmot, and we cannot escape what we have known for 20 years: that the biggest impact on survival, quality of life and outcomes is poverty—and the biggest driver of poverty is austerity.

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[Jackie Doyle-Price]

The right hon. Gentleman knows that we have made tackling that a priority. It is too early to draw any conclusions. It is the case that poverty is a big source of inequality, but we need to do more work before drawing conclusions. Having developed the evidence, we will act. There is a reason that we have developed a national maternity safety strategy. There is a reason we are focusing resource on the perinatal phase, because we recognise it is critical. We will also continue to spend money on the healthy living supplements to give children a better start in life and to tackle some of those inequalities.

[Dr Whitford]

The Minister accepts in her speech that poverty is a big driver of these changes and talks about doing more, but we expect that over the next few years another quarter of a million children will be driven into child poverty. It is not a matter of doing more. In fact, the policies at the moment are making the situation worse.

[Jackie Doyle-Price]

I do not accept that. The real issue for us as a Government is being able to make those interventions that address the sources of inequality. It is about giving practical steps, which I will come to in more detail.

The hon. Member for Sheffield, Heeley referred to the article in The BMJ by Hiam and Dorling about the spike in mortality and winter deaths. She was absolutely right to highlight that. We must pay attention to emerging studies. However, using the total number of deaths can be misleading and needs to be put in the broader context. It does not take account of the ageing population and the fluctuations in population numbers. We use the age-standardised mortality rate as the accepted measure, which looks broadly stable. Clearly this is not something we should be complacent about, and we should continue to keep a very close eye on trends in those numbers.

I mentioned people with learning disabilities living for 20 years less than the rest of us. It is good that that figure has come down since 2000. Their life expectancy has risen by seven years since the millennium. We must encourage that direction of travel by supporting them to live full, healthy and independent lives. That goes to show that having better health is not just an issue for the NHS and health services, but is about having more support to get people into work and to help them to live in the community. We need to use every interface with the state to achieve that.

If we take a lifestyle approach to securing the best possible health outcomes and tackling inequalities, an individual’s start in life is the beginning of that. We are focusing on pregnancy through early years and into old age to ensure that every child gets the best start and journey through the rest of their life. Public Health England is leading programmes to ensure that women are fit during pregnancy. It is leading programmes to ensure that children are ready to learn at two and ready for school at five. We want to continue to support smoke-free pregnancy, which leads to better health for children. Central to that is local commissioning driving best-quality service and interventions as appropriate.

We are obviously very concerned about childhood obesity. If we do not tackle it, it will set people up for poor life expectancy in the longer term. It is worrying to see the number of children entering school at the age of five who are already obese. We need to leave no stone unturned to achieve early intervention. Broader public education about the impact of sugar is helping, but there is much more we can do to encourage people to adopt healthier lifestyles.

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[Jackie Doyle-Price]

I cannot give the hon. Lady that information now, but I will write to her.

Alcohol is a source of poor health outcomes, so we are also doing much to tackle that. I am in dialogue with Members on both sides of the House about supporting the children of alcoholic parents, recognising that they are a particular need group. I thank those hon. Members who have been associated with that.

[Dr Whitford]

With Scotland having been the first place to ban smoking in public places, and now moving forward with minimum unit pricing for alcohol, will this Government consider following that lead for England to tackle alcohol?

[Jackie Doyle-Price]

I am grateful for that point, which consideration is being given to in the Department. There are any number of tools that we could use to tackle alcohol. Probably the most important thing is to give the message that unsafe drinking is bad for the health. It is always interesting to learn from Scotland’s experience, and we will keep an eye on that.

Tobacco is a major cause of poor health. It is worth noting how much progress we have made over decades to reduce the prevalence of smoking. That should lead to better health outcomes, but that has yet to be seen.