Coastal Communities (Health) Bill

Steff Aquarone Excerpts

Friday 13th November 2026 Commons Chamber

[Steff Aquarone (North Norfolk) (LD)]

I beg to move, That the Bill be now read a Second time.

It is my privilege to introduce this Bill today. I thank the Clerks from the Public Bill Office for their support in bringing it to life, and colleagues from along our coastline for their expressions of support for it.

Along our coast, people live sicker and die younger. Five years ago, the chief medical officer laid out the evidence, and today this House has an opportunity to act on it. Fresh from steering the nation through the pandemic, Professor Sir Chris Whitty sought to tackle another major challenge: he published a seminal report outlining the health inequalities faced by coastal communities across our country, which include mine in North Norfolk. The findings are stark and shocking, but clear: across a range of measurable factors, those living in coastal communities were worse off—higher rates of coronary heart disease, lung conditions, obesity, substance abuse and addiction, and mental ill health. Their life expectancies were lower, and the percentage of those lives lived in good health was lower, too.

We are an island nation. For an island nation to have poorer health outcomes in coastal areas is an unacceptable failing. The evidence exists, and the recommendations exist. What is missing is a system that turns them into action and makes someone answerable when that action falls short. The things that Professor Whitty outlined are not news to many of us in coastal communities. We understand the challenges we face, and we live with them daily. What they exposed is how much coastal communities have in common in facing down these challenges, and how much more we have in common with our coastal neighbours than we do with many of our inland neighbours.

Our coastal communities could be a powerful force, and they need to be if the Government are to deliver their ambitions for growth, green energy, strengthened industry, and national defence and security. If our communities are sicker, those aims will all be harder to achieve. For too long, the issues of health and wellbeing in our coastal communities have not been part of the wider conversation about tackling health inequality. I introduced this Bill because I am determined to ensure that my community in North Norfolk, and communities anywhere on our nation’s coast, is being properly represented.

Let us look at the inarguable facts. Professor Whitty’s findings continue to stack up with more recent research. An article published just weeks ago in the Journal of Public Health found that coastal communities in the south-east have life expectancy four years lower than their inland neighbours. In the east of England, it is three years lower. I have spoken before about how these inequalities can even be seen within counties; there are notable differences in life expectancy at either end of the Acle Straight in Norfolk, between Broadland and Great Yarmouth, despite their being only a few miles apart. Research from University College London, published in the British Medical Journal over the summer, also shocked me. It spoke of

“people who grew up and stayed in coastal areas becoming more likely to develop morbidity from midlife compared with those staying in inland areas and…the people who move to coastal areas are sicker compared with those who move away from coastal areas.”

I want the House to reflect on that for a moment. We have evidence that suggests that for people in coastal communities, the best way to stay healthy could be to leave—and for those who are not there currently, not to move there. This is an existential threat to coastal communities as we know them.

Action is not a choice any more; it is a necessity. This matters to the Minister with responsibility for health inequalities, the right hon. Member for Kingston upon Hull North and Cottingham (Dame Diana Johnson), who is not in her place today. She is a respected champion and hard worker for the fine city of Hull. In her area, people will live only 53 years of their life in good health. The average age of MPs elected to this place in 2024 was 48, so were the average MP to become an average resident of Hull, they would have only five years of good health left. I am sure many of us still have a great many things we wish to do in our lives that are reliant on our good health. How would we react to being told that we had five years before our health started to become noticeably and impactfully poorer? That is not acceptable for the people who live anywhere in the country, and I implore the Minister to support the Bill and make a change for all our coastal constituents.

The Bill makes two straightforward demands: a duty to act and a strategy that brings Government together to deliver. As I said during the Health Bill debate, the Government’s current aim to have a duty to tackle health inequality is commendable, but as drafted it is flawed. There are no safeguards to ensure that coastal communities see the benefits of any of this work. Being at the end of the line, often disparately populated and with difficult challenges to tackle, makes it possible that the Government will overlook such communities in favour of tackling health inequality in larger, inland metropolitan areas.

[Sean Woodcock (Banbury) (Lab)]

I congratulate the hon. Member on introducing an important debate on health inequalities to the House. My constituency is inland but largely rural, and shares similar issues with health inequalities to those that he raises, because of transport and access to services. Does he think that by confining the discussion to coastal communities he is stifling a much more important debate about health inequalities across the country more generally?

[Steff Aquarone]

In fact, I would say to the hon. Member that in order to tackle inequality truly we need to work from the outside in. In doing so, we would surely bring into line all the rural inland communities of which he speaks, which I do not doubt share many of the same issues that I am discussing today. If we start with the places the system finds hardest to reach, then we can design services that work there and work inwards. Otherwise, a national average can improve while the communities with the greatest barriers are left exactly where they were.

[Amanda Martin (Portsmouth North) (Lab)]

Does the hon. Member agree that the men’s health strategy is working from within, and that having diagnostic, GP and mental health services available at farming auctions is a great move forward by this Government?

[Steff Aquarone]

That is a wonderful example of how designing from the outside in can work. We have seen that with buses and with broadband, and it is plain that we suffer the same with all forms of health services. The former Health Secretary, the right hon. Member for Ilford North (Wes Streeting), said:

“If Australia can effectively serve communities living in the remote outback, we can meet the needs of people living in rural and coastal England.”

[Caroline Voaden (South Devon) (LD)]

In my constituency it can take a very long time to get to the nearest hospital because of small, narrow lanes, and it can be almost impossible in the summer when there is heavy holiday traffic. The integrated care board has talked about merging emergency cardiac care between three hospitals, which would make the journey so long that people would literally die en route to the hospital. We have been campaigning hard for the ICB not to do that. Does my hon. Friend agree that while merging some services may be the way forward to enable ICBs to cover their costs, choosing a service like emergency cardiac care, where the time taken to get to the hospital, and therefore the distance travelled, is absolutely crucial to survival, is the wrong area to start when looking at service provision?

[Steff Aquarone]

That surely defies all sense. I understand, as my hon. Friend alluded to, that for reasons of professional development and training it may not be possible to deliver all services in all areas, but acute and emergency care is surely beyond reproach. I am yet to hear any understanding or potential safeguards for that risk from the Government, either here or in the other place. There was no acknowledgment of it when I brought forward and spoke to an amendment on the Health Bill, or when Lord Patel did so in the other place. Coastal communities deserve an explanation of why the Government are not ensuring that health services are delivered for them.

[Pam Cox (Colchester) (Lab)]

The east of England has one of the longest coastlines of any region, so we too are familiar with the challenges faced by coastal communities. The University of Essex has an exemplary centre for coastal communities, led by Dr Emily Murray, an epidemiologist and public health expert. Will the hon. Gentleman join me in commending the work of that centre and in encouraging Ministers to meet representatives from the centre to hear their recommendations?

[Steff Aquarone]

I surely would, on condition that the hon. Lady allows me to join them, because I would really like to hear more about that work. I am sure it would have a great impact on my part of the east of England, which is quite a big part of the United Kingdom.

When I have tried to question the Government on the specifics of their work, I have not received anything substantive. In July, I asked how many meetings the Minister for health disparities had attended in relation to coastal health inequalities this year, and I was told:

“Ministers in the Department meet regularly on a range of topics, including tackling health inequalities, to which coastal inequalities are closely linked.”

I asked which meetings had taken place; I received a general assurance. I asked what specific work was being done, and I was referred back to that general assurance. Ministers must be able to tell Parliament what they are doing, who is responsible and what has changed. It is becoming a worrying theme that coastal health inequality is being kicked out to sea, so I hope the Minister can provide some straight answers on what the Government have done and will do to make a difference.

People in coastal communities want the reassurance that this House, which has more than 100 MPs who represent coastal communities, is placing a legal duty on Ministers responsible for tackling the issues that matter to them. This lack of action or record of delivery is growing more and more worrying.

The other part of my Bill relates to a cross-governmental coastal health strategy. It is rare for politicians to admit when an idea is not theirs, but I will admit that this is not my idea. In fact, it is not even very new. It was a core recommendation of the Chris Whitty report in 2021.

I am sure that the Government will be keen to point out their existing health plans and strategies. While those do important work in places, they will not do enough to recognise the specific challenges of delivering coastal healthcare. Coastal communities suffer from the challenge of the half-compass effect when seeking access to healthcare. It might sound obvious, but when residents in Mundesley or Cley seek to access healthcare, half the compass directions they could travel in would take them straight into the North sea. To my knowledge we are not yet building GP surgeries or dentists there. Yet we still risk planning services as though patients can travel in every direction.

This morning I received a letter from a constituent in Holt, who had been referred by his GP for an MRI scan but was told there was only availability at the Norfolk and Norwich hospital, some 25 miles away. It is a six-hour round trip on public transport. He cannot afford a taxi and there is no hospital transport available, so he has declined the test. He asked me, rightly, how many other constituents find themselves in this situation because of inadequate access to healthcare on the coast.

Geography has to shape provision. If we take a one-size-fits-all approach to healthcare delivery, it will only be half as effective for coastal communities. A strategy that pulls together all parts of government that have an impact on and interest in tackling coastal health inequality is important to bring together the action necessary to face up to this challenge.

This speaks to the core of my vision for a country that works for people, to rewire Westminster around the lives that people lead. A patient misses an appointment because there is no bus. Their health deteriorates because their home is damp. They cannot get the help that they need because the local service cannot recruit. Westminster files those problems under different Departments, but that person experiences one life. We should organise government around that life. We should give people responsibility for the outcome, the resources to deliver it and the funding and authority to work meaningfully across Departments, not just within annual budgets.

Tackling coastal health inequality is a great opportunity to show that this can work. This Bill does not list exhaustively all the things that the strategy should do, but it does touch on many of the key issues that Professor Whitty identified and that I and my constituents see and live with every day.

The strategy would look at the recruitment and retention challenges of coastal communities, which come from being at the end of the line and lead to an extreme workload for those who do healthcare work in our areas. The chief medical officer’s report outlined how there are 14.6% fewer postgraduate medical trainees, 15% fewer consultants and 7.4% fewer nurses per patient in coastal communities. I have seen this at first hand in my area when it comes to securing enough trained pharmacists to keep community pharmacies open and operating in our coastal towns. Many will remember the scandal of the failure of Jhoots. It was noticeable how many coastal towns were impacted by that collapse. The localised factors of transport, environment, employment and more would also be addressed in this strategy.

When seeking to address health inequalities, the Government need to truly understand how being coastal affects Cromer and Sheringham differently from Whitby or Grimsby. There are different characteristics of the coast—fishing, ports, tourism, rurality—and all need their solutions to be well tailored.

To that end, I strongly encourage them to take a look at the excellent work of the Coastal Navigators’ Network, which has been taking on this great challenge and building a nationwide network of local government and health professionals to find solutions to challenges faced by coastal communities through the lens of opportunity. They understand how that investment, and the time and energy that is spent getting to the root causes of much of coastal inequality and deprivation, can pay excellent dividends in both wellbeing and economic terms.

The test of the strategy will be what changes—how staff are recruited and retrained, how patients reach appointments, and how investment prevents ill health. Each commitment needs an owner, a timetable, and a measure of success. We cannot have this becoming another nice document that becomes confirmed to a fate similar to that of the “display department” in Douglas Adams’s “Hitchhikers Guide to the Galaxy,” meaning that we might find the coastal health strategy

“in the bottom of a locked cabinet, stuck in a disused lavatory with a sign on the door saying ‘Beware of the Leopard’.”

Publishing a strategy is not the same as delivering it, and Ministers should return to the House and tell us what has improved, what has failed, and what they will change.

When Chris Whitty was on our television screens every night, giving us evidence and making recommendations backed by data and in the public interest, the Government listened to him and trusted him. We listened to him and trusted him. There has been no change in his methods when assessing the challenges of coastal communities. His reasoning and recommendations are just as well thought out as during the pandemic. Coastal health inequality is another challenge of our times, and the data show that we are losing the battle. We cannot allow this approach of sidelining coastal issues, or assuming that they could be picked up by another non-specific piece of work as an afterthought. The coast is where the country begins for millions of people. It must not be where the Government’s ambition ends. Give this Bill its Second Reading, and make improving healthcare a responsibility that Ministers must answer for.

[Several hon. Members rose—]

--- Later in debate ---

[The Minister for Social Care and Mental Health (Alison McGovern)]

I begin by thanking the hon. Member for North Norfolk (Steff Aquarone) for bringing forward this Bill and for giving the House the opportunity to debate, on all sides of the question, the health and wellbeing of our coastal communities. I trust that the hon. Member will be reassured that, as a Minister and a constituency MP for Birkenhead who lives right next to the edge of the country, on the banks of the River Mersey and proximate to the Irish sea, I understand this issue very well.

The Government share the concern that lies behind this Bill. We recognise that there are significant and persistent health inequalities in some of our coastal communities, and it is absolutely right that the Government address them. However, having listened to the debate, I am struck by some of the comments that my hon. Friends made about the various health inequalities that persist across our country. I agree with my hon. Friend the Member for Erewash (Adam Thompson) that the underlying economic circumstances are the determinants of health. There should be nothing inevitable about somebody experiencing poorer health, or spending fewer years of their life in good health, simply because of where they live, yet in far too many communities, including coastal communities, poorer health outcomes sit alongside deep-rooted social and economic disadvantage.

These challenges are not new. They were set out powerfully in the chief medical officer’s 2021 report on health in coastal communities, and the importance of place to our health has been reinforced by the chief medical officer’s latest annual report on health in rural areas and small towns. We in this House all thank the chief medical officer for his considerable work on this subject. That report is particularly relevant to today’s debate, because rural, small town and coastal communities frequently overlap, and many of the challenges that it identifies will be familiar to Members of this place. It highlights the challenges of accessing and providing services across greater distances, limited public transport, ageing populations, workforce recruitment and retention, housing pressures and hidden deprivation.

Importantly, the report also emphasises that health and social care services need to be designed around the needs and circumstances of local populations. That matters, because when we talk about health inequalities, we cannot simply talk about differences in people’s experience of the NHS, as I said yesterday in a speech on the work that we are doing on social care.

[Steff Aquarone]

Given that we have limited time for a full ministerial response and that the Minister obviously has an interest in this subject, as do I, will she agree to meet me or set up a meeting with the relevant Minister to discuss coastal health inequalities further?

[Alison McGovern]

As you know, Madam Deputy Speaker, I never refuse a meeting with any Member of this House. I have my surgeries on Wednesdays, if the hon. Member would like to pop in and talk about mental health or social care. If he wants to talk about general health inequalities, I refer him to the Minister for Public Health and Patient Safety.

Of course, high-quality healthcare matters enormously to all of us. Our health is shaped long before we arrive at a GP surgery or a hospital waiting room. It is shaped by the homes in which we grow up and live, by our education and the opportunities available to us, and, as Labour Members know only too well, by whether we have secure and rewarding work. Our health is also shaped by our income, by the transport available to us, by our environment, and by whether the communities in which we live give people the opportunity to lead healthy and fulfilling lives.

Place and geography matter for health, but tackling inequalities between places requires action within healthcare and far beyond it. That is an analysis with which this Government agree, and I have not heard dissenting opinion in the House this afternoon.