Health Inequalities

Philippa Whitford Excerpts

Wednesday 4th March 2020 Commons Chamber

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

Obviously I welcome what the Minister has said, but she talked about starting to take action and, given that we have had Conservative-led Governments for the last decade, I find it a bit surprising to hear talk of starting to take action now.

Health is much wider than the NHS. This is a confusion that many people make. Health is about everything else. In his acclaimed review “Fair Society, Healthy Lives”, Michael Marmot defined the social determinants of health: the conditions in which people are born, grow, live, work and age. He explained that the variation was driven by inequity in power, money and resource. The review set out how public expenditure could act on the social determinants to reduce health inequalities. The problem is that, although it was welcomed by the coalition Government—there was even a public health White Paper—no action was really taken. In contrast, in 2016, we saw essentially the repeal of the Child Poverty Act 2010, including the reduction targets to get more children out of poverty. In the 2020 Marmot review, therefore, we see not success over the past 10 years, but things going in the wrong direction.

[Karin Smyth (Bristol South) (Lab)]

I agree with the hon. Member about the social determinants of health. Does she agree that, going back 10 or 15 years, to before 2010, the Labour Government appreciated those determinants and directed public policy to that end?

[Dr Whitford]

I do. I respect the work that Labour did, and child poverty was falling. Interestingly, the upturn in child poverty we have seen did not happen with the crash in 2008; it happened after the 2012 welfare changes. That is striking. The impact of Government policy has been austerity in every way and in every approach to individuals, families and communities. We have seen slow income growth for the vast majority of people over the last decade. There has been absolute inequality. The majority of the growth that there has been, has been at the top. The national living wage simply is not a living wage. More people are in insecure work—zero-hours contracts, the gig economy—and do not have protections. As the shadow Health Secretary mentioned, in all the discussion about covid-19, we have been trying to highlight that people on low pay and insecure contracts do not get sick pay, yet we will be asking them to stay at home for two weeks and self-isolate. In the meantime, the wealthiest people have actually trebled their wealth. So categorically we have not all been in it together over the last 10 years.

In addition, we have seen a restriction on public expenditure. The regressive welfare cuts of 2012 and 2016 have reduced support for families by 40%: the benefit cap, the benefits freeze, the two-child limit, the five-week wait for universal credit, which puts people in rent arrears and debt, personal independence payments, the bedroom tax. Eighty per cent. or more of these cuts have affected women directly because they tend to be lower paid, to be carers and to rely more on services. In the main, they are responsible for children. The disabled have also been particularly hard hit. We have not seen a cumulative impact assessment of female lone parents who are disabled and have three or more children. Some of them have had their income slashed.

There have been cuts to local government and services. Interestingly, the least deprived areas face 16% of cuts, while the most deprived on average had 31% cut from their local government budget. I have heard Labour Members talk about between 40% and 60% cuts in their local government budgets. There are changes in the pipeline to move £300 million from local authorities in the north to the south. I wonder if that will be reversed now that the Conservative party has won some seats in the north.

[Jamie Stone]

Some years ago, when I was a councillor, I had a harrowing case involving a young female constituent who was clobbered by the bedroom tax. She has multiple sclerosis and she was going to lose a lot of cash. I want to put on the record my thanks to the Scottish Government for the action they took to ameliorate and offset that tax.

[Dr Whitford]

I thank the hon. Member for that recognition. The Scottish Government are spending more than £100 million every year in mitigating some of these cuts—they pay the bedroom tax and they have set up the Scottish welfare crisis fund—but that is money that should be going into devolved areas, not patching up austerity decisions here; it is not the role of the Scottish Parliament just to mitigate.

Public health in England has been cut by £850 million—again, the greatest cuts to the poorest areas—and it is exactly the same with future planned cuts. This has led to cuts in smoking cessation projects. There is no point standing up and talking about the importance of stopping smoking—we all know that. People who have smoked for decades need help to stop and those services are critical. We have also seen cuts to drugs and alcohol projects and to sexual health projects, and all those have an impact on the poorest people.

The Minister, who is no longer in her place, might have listened to Dame Carol at the drugs summit in Glasgow but, sadly, the Minister for Crime and Policing, the hon. Member for North West Hampshire (Kit Malthouse), did not. He came to Glasgow, made his speech and then left before all the expert evidence was given. We also hear of a social care gap across England of over £6 billion. Again, that affects women if they have to give up work to look after elderly relatives or disabled children. This rolling back of the state has affected the social determinants and increased health inequalities. Child poverty has increased, as we have heard, with 4 million children affected, and 1,000 Sure Start centres have been closed. Education funding is down. There is a housing crisis and therefore a rise in homelessness. People with insufficient funds to afford a healthy life are depending on food banks, and deprived communities are simply losing hope.

Poverty is simply the biggest driver of ill health and has the biggest individual impact on life expectancy. The increase in life expectancy in England has stalled for the first time in 120 years—the first time since 1900. The gap between the most and least deprived has widened: the gap is now almost 10 years for women and the life expectancy of some women in areas of the north-east of England has dropped by almost a year.

[Dr Murrison]

I always listen with great respect to what the hon. Member has to say, but given that the SNP has its hands on many of the levers relating to the things she has discussed this afternoon, I am assuming from what she has said that Scotland is in the wonderful position of having narrowed health inequalities. Could she perhaps compare and contrast what has happened in Scotland with what has happened in the rest of the United Kingdom? I rather think that the two are very similar.

[Dr Whitford]

If the right hon. Gentleman waits to hear the rest of my speech, I will highlight some of the differences in child poverty.

We have seen life expectancy for those women falling, but when we look at healthy life expectancy, the gaps are even bigger. Time spent in poor health is increasing, and that of course puts pressure on the NHS and care services. We in this Chamber are always discussing the pressure that the NHS is under. Emergency admissions in areas with low life expectancy are double the numbers in wealthier areas. Women in deprived areas will now spend two decades or more of their life in poor health. Improving the healthy life expectancy by at least five years was actually a policy in the industrial strategy, so that people could be active and engaged in the economy, but what we have seen is an adverse effect both on health and health equality.

We know that someone’s health for most of their life is determined in the early years, even starting when their mother is pregnant. Child poverty is central to this and it is rising. It is defined as children in households with less than 60% of median income. England had child poverty down to 27%, but it is now 31%. Scotland had it down to 21%, and it is now 24%. That is because welfare changes are taking place right across the UK. Poverty is decided in this Chamber; it is not decided anywhere else, and the Scottish Parliament, as we have heard, spends a lot of energy on trying to mitigate it.

As we know, housing costs are a major contributor because of the shortage of housing. This is a rising issue among the poorest: 38% of the poorest will spend 30% or more of their income on rent or housing. That figure was 28% 10 years ago. The Scottish Government have built 87,000 affordable houses, and that is part of why our child poverty level is lower. It is the housing impact. In the 2015 general election, the Conservatives promised 200,000 starter homes. They built precisely zero.

Some 4 million children are growing up in poverty, and that will affect their whole lives. Whenever the issue is raised at the Dispatch Box, we are told that unemployment is down and that people must work their way out of poverty. We are told that that is how we change things, yet two thirds of those children already have a working parent. The problem is that all of this drives ill health.

[Munira Wilson (Twickenham) (LD)]

Does the hon. Lady agree that children living in poverty are more likely to suffer mental health issues? They face a double whammy, as the Children’s Commissioner recently found, in that there is also a postcode lottery in spending on children and young people’s mental health, which varies between about £15 and £200 per person, depending on the area.

[Dr Whitford]

I totally accept that, and actually, children in low-income families have three times the rate of mental health problems. Three-year-olds in a household with an income of less than £10,000 have two and a half times the chronic diseases, and by the time they start school, we find that the poorest children have over a year’s gap in vocabulary. It is important to try to balance that. That is one reason that the Scottish Government are investing in early learning for all children—all three-year-olds and four-year-olds and vulnerable two-year-olds—and also have put in a pupil equity premium that allows the school to have additional funding to try to meet the challenge where they are serving poorer communities.

The problem starts before the child is born. A woman carrying a female child is carrying her grandchildren, because the eggs in a female are formed in the womb. That means that if that mother is badly nourished, she will be affecting health for the next two generations. That needs to be changed, which is why we have invested. We have the best start grant, which goes to the pregnant woman at birth, when the child starts nursery and when the child starts school. There is also food support, because we need to change this right at the start of life.

Health and wellbeing should be an overarching priority for any Government and for all their citizens, regardless of where they live. This requires a “Health in all policies” approach, not saying, “Clean air is DEFRA’s issue.” We need this as a cross-government policy whereby every decision is checked to see whether it will improve the physical, mental and environmental wellbeing of the citizens the Government are responsible for.

[Several hon. Members rose—]

--- Later in debate ---

[Derek Thomas (St Ives) (Con)]

I am glad to be able to speak in this debate. Cornwall and the Isles of Scilly, which I represent, have a real issue with health inequalities, and I was glad recently to ask the Prime Minister to take a look at health inequalities in dental care. That has been touched on already this afternoon in relation to children. As I have said previously in this Chamber, 60% of adults in my constituency and across Cornwall and 40% of children have not seen a dentist in the past year. It is not so much a lack of funding—the funding actually gets returned to NHS England—as a lack of dentists prepared to work in the NHS. I am glad that the Government’s amendment states that they are

“committed to level up outcomes to reduce the health gap between wealthy and deprived areas, and supports the Government’s commitment to delivering long-term improvements for everyone no matter who they are, where they live or their social circumstances.”

[Dr Whitford]

Does the hon. Gentleman agree with me that part of the problem is the dental contract, whereby dentists are not rewarded for the amount of work they do and certainly not rewarded for preventive care?

[Derek Thomas]

I do agree with that. I did not want to get into party politics, but the Labour party gave the 2006 dental contract to dentists, and we have seen the decline in the availability of dental care in Cornwall from that point. I understand that it cannot be reviewed for another couple of years, but I believe there is work that can be done before then to respond to the challenge, and that is what I want to raise today.

Since I last raised this issue in the House, I have been asking my constituents about their experience. I have heard about disabled people who have to consider accessibility—they cannot get in to the dentist’s and therefore cannot get an appointment. Pensioners are unable to afford private treatment, and have been left stranded without provision for years. Some were getting NHS treatment, but then practices stopped offering it, as they are unable to keep up with demand. Pregnant women do not get access to NHS dental care for the entire pregnancy, but are offered it a long time afterwards, even though it is free during a pregnancy. People have ended up travelling further and further, and I heard of constituents travelling to Bristol and London to get the dentist care they need, which cannot be good for us as we try to reduce our carbon footprint. As I have said, there is also a lack of access for children.

In the time I have, let me share some of the comments that have been made. Mike left the Royal Navy and had a three-year wait for an NHS dentist. Then he got a dentist, but appointments have been constantly cancelled, so he is not seeing a dentist. He believes that the armed forces covenant should offer dental provision. Fred said that he has been waiting five years to get a dentist in Cornwall, so he is now registered at a London dentist, even though he lives in my constituency 300 miles away.

A gentleman who worked away a lot, but his family was in Cornwall, said that he, sadly, did not visit the dentist for two years so was “removed” from the dentist’s list. He had cracked his tooth, but was not able to see a dentist, despite his wife and children still being registered and able to get an appointment. Another gentleman who had been living in Penzance for eight years had to wait two years to be placed at a dentist’s. He got a dentist, but then found that they kept cancelling, so he had not seen a dentist in three years. There is story after story of this happening.

There is light at the end of the tunnel. A lot of work was done last summer by the former MP Sarah Newton and me and other colleagues in Cornwall, and a plan was put in place. NHS England said that it would engage with the national NHS England dental workforce team to look at a more innovative way to attract dental staff to Cornwall and put forward a plan by the end of the year—that was last year. It also said:

“Work is also under way at a national level to identify solutions to the dental recruitment and retention pressures in NHS dentist services, and to understand and address the constraints of current national NHS dentist contracts”,

which has been referred to. I would like the Minister to look at what has happened to the plan Cornwall was promised at the end of last year and what is happening to the review that is going on across the county.

We are doing work locally, but it needs the commitment of Government and others. There is an irony in that we train a lot of dentists in Truro but they do not seem to stay in Cornwall so this also needs the involvement and commitment of the Peninsula dental school, as well as NHS providers and NHS England, to get a grip of this and to ensure that children and adults, particularly vulnerable adults, are no longer discriminated against and no longer face these health inequalities.

We must come together quickly and creatively to ensure that dental care provision is addressed. As we have heard, if we get it right very early in life then we save ourselves a whole host of problems later on.