Public Health: County Durham

Roberta Blackman-Woods Excerpts

Wednesday 12th June 2019 Westminster Hall

[Dr Roberta Blackman-Woods (City of Durham) (Lab)]

May I say what a pleasure it is to serve under your chairmanship, Mr Owen? I thank my right hon. Friend the Member for North Durham (Mr Jones) for bringing forward this important debate. In 2013, there was a general welcome for the transfer of public health funding to local government, because it meant that public health and addressing public health issues could be integrated into the council’s service delivery objectives to better promote public health objectives.

On transfer, the grant to County Durham was £44.5 million, based on an assessment of health needs in the county by professionals—albeit one heavily influenced by the Government’s austerity programme. It is therefore extremely alarming that the Government now plan to move to determining the county’s grant level not on need but according to a new formula, under the huge misnomer of the “fair funding review”—it is anything but. The public health grant to County Durham will be reduced by a massive 38% while resources are transferred to more affluent areas of the country that have much better health outcomes. That is clearly madness and cannot be right.

The public health team in County Durham has done a good job, despite facing the hugely complex health issues discussed in some detail by my right hon. Friend. The county has an industrial past of heavy industry that has left a huge legacy of negative health impacts on the local community. Despite that, and through use of the public health grant, public health professionals, to whom we all pay tribute this afternoon, have done much. They have reduced smoking prevalence and teenage conceptions, and they also provide excellent support for vulnerable families on health and wellbeing issues, including access to mental health services. Those positive changes will be very much put at risk by the massive reduction in funding. In fact, given the severity of the problems Durham faces, it should be given more funding, not less.

Public health professionals in Durham have to address not just the problems of our industrial legacy but high current levels of poverty, because proper regeneration of the county has not taken place as yet. For example, just one food bank said that it gave out 20,000 emergency food bank parcels in Durham last year. We are talking about massive levels of poverty. Almost a third of children in County Durham are being brought up in households affected by poverty. Increasingly, such households are those with parents in work, sometimes having to do multiple jobs just to make ends meet.

[Mr Kevan Jones]

Under the last Labour Government, my hon. Friend, along with my hon. Friend the Member for Washington and Sunderland West (Mrs Hodgson), pioneered a free school meals initiative. Is she alarmed that, as I learned yesterday, the national school breakfast programme, which costs only £12 million nationally and affects quite a few schools—primary schools in particular—in her constituency, my constituency and other parts of County Durham, has still not had its funding guaranteed for next year?

[Dr Blackman-Woods]

My right hon. Friend makes an important point, which I am sure my hon. Friend the Member for Washington and Sunderland West (Mrs Hodgson) and I will take up in the coming weeks. That is an indication of how little the Government seem to be concerned about the children growing up in poor households.

Let us look at the Durham situation. The starkest indicator is the seven-year healthy life expectancy gap between females in Durham, currently at 59, and those in Hertfordshire, where it is 66, and Surrey, where it is 68. That gives rise to the question of why the Government are transferring resources from County Durham to Surrey and Hertfordshire. I know the Minister is new to her post, but it would be helpful to get an explanation of why the Government think that is a good idea, because we have not had one so far. The appalling health inequality is compounded by overall life expectancy figures, which for women are 81 in Durham compared with 84 for Hertfordshire and Surrey. There is a similar gap for men.

Let us look at other measures. Suicide rates in County Durham were above the national average, with 20.6 deaths per 100,000 of the population for males. On mental health, the rate of young people admitted to hospital because of self-harm is significantly above the national average. On alcohol, 33.8% of people in County Durham drink more than the low-risk guidelines recommended, and 290 people died due to alcohol-related problems last year. There were also 12,500 hospital admissions and 108 road traffic accidents. That suggests a significant problem that needs to be addressed.

Furthermore, the percentage of mothers smoking at the time of delivery is above regional and national averages. As my hon. Friend the Member for Sedgefield (Phil Wilson) made clear, breastfeeding rates are low, yet we know that it provides the best nutrition that babies and young children can get. Seven out of 10 adults in County Durham are overweight or obese, significantly more than the national average, and cardiovascular mortality rates are also higher than the national average.

I could go on with endless statistics, but we are making the point that County Durham is an area with high levels of disadvantage and poverty. It is below the national average on almost every public health indicator imaginable, yet what are the Government doing? They are not giving additional funds to address those problems and ensure that our services continue to improve; they are threatening to take money away.

The workforce would be significantly affected by this measure. There would be a significant reduction in the number of visits that health professionals could make and the universal work on emotional wellbeing would be removed. Instead, only higher level and more targeted work would take place, although we know that misses most of the families and individuals who would benefit from services. Other prevention priorities, including visits and programmes trying to address problems around smoking at the time of delivery, breastfeeding, unintentional injuries and obesity, would also be reduced. The service would have to focus on safeguarding, which would increase inequalities, and issues would be missed.

I could go on and on. We have already seen a massive reduction in services. For example, my constituency has no Sure Start centres operating, which means there is nothing in place to bring together services that could support very vulnerable families. Can the Minister look at that issue as well?

What do we want the Minister to do? The point was put forcefully by my right hon. Friend the Member for North Durham: we need a commitment from the Government to increasing public health funding in line with need; an extension to public health funding to be used in areas where the grant has been utilised effectively; and clarity on the timescale for decisions. We have already seen concern in County Durham about future funding, especially from the voluntary sector organisations that do much of the heavy lifting in terms of providing services to improve public health outcomes. The Government do not seem to be aware that funding for such organisations is often precarious and that they need some certainty from the Government to invest in staffing and services for the future.

The Government should certainly not be moving money from areas with the greatest health inequalities to those with the least health inequalities. They should be carrying out an impact assessment of any funding decision, so that we are really clear about what the impacts of that massive reduction of 38% in County Durham would lead to. As my right hon. and hon. Friends have said, this is an issue across north-east England. I look forward to hearing what the Minister will say to address this problem.

--- Later in debate ---

[Seema Kennedy]

No, I was repeating what the shadow Minister had said.

The recommended formula, which would create winners and losers in terms of overall levels of funding because of the disparity in historical spend compared with current need, has not been implemented because of the Government’s intention to extend the system of retained business rates. We continue to review the position, and future spending levels will be decided as part of the spending review, where we will review all available evidence.

I commend all local authorities on the efforts they are making to improve population health, as well as third-sector groups such as the children in Cleves Cross with their edible walkways. We continue to believe that local authorities are best placed to make decisions about the services that best meet the needs of their populations.

[Dr Blackman-Woods]

I am sure the Minister would accept that any formula that moves services from areas of relatively high need to areas of low need cannot be working properly. Does she also accept that it is simply not fair to push the onus to provide more services on to local authorities? As my right hon. Friend the Member for North Durham (Mr Jones) made clear, Durham County Council’s budget has been cut by 60% since 2010.

[Seema Kennedy]

I believe that local authorities and local communities are the right place for public health to be situated, because they best understand the needs of their communities.