Public Health: County Durham

Sharon Hodgson Excerpts

Wednesday 12th June 2019 Westminster Hall

[Mrs Sharon Hodgson (Washington and Sunderland West) (Lab)]

It is a pleasure to serve under your chairmanship this afternoon, Mr Owen. I thank my right hon. Friend the Member for North Durham (Mr Jones) for securing this important debate and for his excellent speech. I also thank my hon. Friends the Members for Sedgefield (Phil Wilson) and for City of Durham (Dr Blackman-Woods) for their insightful and powerful contributions.

As I have said many times before, under the Tory-led coalition and the current Conservative Government, public health budgets have been cut by £700 million since 2013, with no financial settlement agreed so far post-2020. As we have heard, that means that vital public health services, such as those for smoking cessation, obesity, sexual health and many more, have been stripped back to the bare minimum. That has consequences: gonorrhoea is at its highest level in 40 years and syphilis at its highest level in 70 years; rates of smoking among pregnant women have risen for the first time on record; and Victorian diseases, such as scarlet fever, whooping cough, malnutrition and gout, have seen a 52% upturn since 2010, with an increase of over 3,000 hospital admissions per year.

Life expectancies are stalling and, in some places, declining, with the north-south divide as wide as ever in terms of health and productivity. For a number of us in this Chamber, it was the north-south divide that drove us into politics; to see it as wide as ever, and not closing, drives us to come to debates such as this one. This is a welcome opportunity to highlight and discuss public health in County Durham.

Overall, health and wellbeing have improved significantly in County Durham, but it still remains worse than the England average. Although it has improved in the north, the rest of the country has also improved, so the gap remains wide. In addition, large health inequalities still remain across County Durham, especially with regard to breastfeeding, babies born to mothers who smoke, childhood obesity and premature deaths. The impact becomes obvious when we look at life expectancy. As we have heard, a child born today in the most deprived areas of County Durham can expect to live between seven and eight years less than one born in the least deprived areas.

With that in mind, it is concerning and shocking that County Durham is the worst affected local authority in England when it comes to cuts to the public health grant. Current predictions suggest that Durham County Council will lose £18 million this year from its public health grants. To put that into perspective—I will repeat the figures we have already heard, because they are more shocking the more times you hear them—this means County Durham will be receiving an £18 million cut to public health budgets but Surrey County Council will receive £14.4 million extra and Hertfordshire County Council will receive a boost of £12.6 million.

What assessment has the Minister made of this funding disparity between councils in the north and south, and the impact that has on health outcomes? Does she agree with me that where there is need, funding should follow? How will the Minister support Durham County Council in delivering vital public health services to those who need them most?

The current grant for County Durham, with a population of 525,000, is £47.4 million, which equates to £90 per head. Does the Minister believe that this is a substantial amount of funding per person to tackle all the public health issues, as well as look at prevention for smoking, alcohol and drug misuse, obesity and weight management? Does she believe that £90 per head is enough to also fund early years services, nutrition and physical activity programmes and support mental health and wellbeing services?

As has already been mentioned, there is a life expectancy gap between the north and south of England: it is clear that money follows higher life expectancies, rather than the other way around—or, indeed, deprivation—as it used to. In County Durham, women have a healthy life expectancy of 59. That is compared with Hertfordshire, where women have a healthy life expectancy of 66, and Surrey, where it is 68.

[Albert Owen (in the Chair)]

To give time for the Minister, can the hon. Lady finish up, please?

[Mrs Hodgson]

Yes, I will. I ask the Minister: when will the Government agree a future funding settlement for public health? I am under the impression that this has been postponed now until after the leadership contest. Local authorities and public health services need to know where they stand. As my right hon. Friend the Member for North Durham said when he opened the debate, we cannot have County Durham or other local authorities being left behind any longer.

[The Parliamentary Under-Secretary of State for Health and Social Care (Seema Kennedy)]

It is a great pleasure to serve under your chairmanship, Mr Owen. I thank the right hon. Member for North Durham (Mr Jones) for raising this important issue, and the hon. Members for Sedgefield (Phil Wilson) and for City of Durham (Dr Blackman-Woods) for their contributions.

The Government fully appreciate the importance of protecting and improving the health of the population. We share hon. Members’ commitment to prevention and public health, which this debate has highlighted. The costs, both to individual lives and to the NHS, are simply too great to ignore.

The population in England is growing, ageing and diversifying rapidly. Some 40% of morbidity is preventable, and 60% of 60-year-olds have at least one long-term condition. Helping people to stay well, in work and in their own homes for longer is vital. As hon. Members have highlighted, the gap in healthy life expectancy between the most and least deprived areas of England is approximately 19 years for both sexes. As somebody who was born in Lancashire and represents a Lancashire seat, I see that disparity in my constituency. It is a great motivating factor for me in my role, as it was for my right hon. Friend the Prime Minister when she set her grand challenge of extending a person’s period of healthy, independent and active life by five years by 2035.

However, we will not achieve that by simply adding five extra years at the end of life; as with many things, the earlier we start, the more we stand to gain. Investment in early years and onwards is essential if we want positively to influence future lifestyle choices, prevent disabling conditions and enable people to contribute fully to society. We must continue to focus our efforts on areas such as digital technology and behavioural science so that we can show the public that the healthy choice is the easy choice.

We are doing work—on childhood obesity, smoking, air quality and more—that has the potential to make a real difference to people’s health and wellbeing. The amount of sugar in drinks has been reduced by 11% and average calories per portion have been cut by 6% in response to our soft drinks industry levy. By 2020, the NHS diabetes prevention programme will support 100,000 people at risk of diabetes each year across England. Last year’s ambitious prevention vision statement and the forthcoming prevention Green Paper will enable us to meet the ageing grand challenge and address health inequalities, supporting people to live longer, healthier lives.

We recognise that the funding position for local authorities is extremely challenging and understand the huge efforts that local government has made to focus on securing best value for every pound it spends. The 2015 spending review made available £16 billion of funding for local authorities in England over the five-year period. I remind the House that that is in addition to the money the NHS spends, which is part of the public health offer on prevention and includes our world-leading screening and immunisation programme and the world’s first national diabetes prevention programme.

Today’s debate has highlighted an important issue about the distribution of funding for local authority public health functions. Historically, funding for public health services in the NHS was left to local decision and was not necessarily based on need, which led to wide disparities in the amount of funding dedicated locally to public health services. Before these functions were transferred to local government, we asked the independent Advisory Committee on Resource Allocation to develop a needs-based formula for the distribution of the public health grant. The introduction of that formula meant that some local authorities received more than their target allocation under the ACRA formula and others received funding under target. In 2013-14 and 2014-15, when the overall grant was subject to growth, local authorities’ funding was iterated closer to their target through a mechanism called “pace of change”.

In 2015, ACRA was asked to update the formula to take account of the transfer of responsibility for commissioning health visiting services from NHS England to local authorities. We consulted on this formula and ACRA made recommendations to Government in 2016. I understand that the public health formula is more heavily weighted towards deprivation than either the adult social care formula or the clinical commissioning group formulation.

[Mrs Hodgson]

It is not working.

[Seema Kennedy]

Of course we want evidence. The shadow Minister says from a sedentary position that it is not working. We did an impact assessment in 2015-16 and we are reviewing all the evidence in preparation for the next spending review.

[Phil Wilson]

Just for clarification, did the Minister actually say that the formula is not working?

[Mrs Hodgson]

No; I said that.